Homestead_Harris STATE FORM 5)569(lU8-10) - - TREASURER FORM T511A
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1.22-8.1
rtar, IMPORTANT NOTICE TO HOMESTEAD PROPERTY,OWNERMANIM
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
4rduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
®causes higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
standard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
information necessary to allow county government to better monitor homestead filings. This information
will be kept confidential and can only be accessed by authorized county officials. The Department of Local
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
..ai i`^.6;,'PARTI: PROPERTY INFORMATION 4 ,z ,aY � .;
Tasnaser Name Property Address State Parcel Number Leal Description;
Jimmy D Harris 1001 S RACE ST 26-12-18-201-003.067-028 SS ADD 226
PRINCETON IN 47670
Complete and return to: IEMEElluGiiuu1Giufliiiu7i iligawiiili iiE
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
'. la- . ,, ., ;.4 y:.;:. %;PART.2:TAXPAYER INFORMATIONS-` ^I- a-; te.... , 1=
Owner 1 . Furst V Middle - Last
Y,(vv. 4531 tic-'nn ri I E
Mailing Address(comber street city,state and ZIP code)
as property
(moot S• eaCL St R-t nc _[c' . I�}--1�-7adb
Spouse First Middle
Last
:SAC\ 1 PVnn 440.TriS
Maaing Address(number and street,city,state and ZIP cede) V I Sarno as property address
L"uo I S t ct 0 e `Ei Pr t r-C $ ym am - Lr1?j1`O
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to receive the
homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions unlawfully,he or
she may be liable for back taxes and substantial financial penalties.
Owner 1 Signature
n Date
•1
r;� CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
� � State Form Sa73 (R6 / 403)
Prescnbed by the DeDartmenl of Local Govemment Finance
INSTRUCTIONS: See revcrsc sidc (or /iling inslrur.fions.
�..- .:_:�.1_..5....._p2::.-. .-.,-.r;-...- ..i_�...,-
'\ FORM YEAR
��� HC10
t?,t.y;., �. ..,,._,,- � -�,,.,_..,._.s._.._.. . . ' - : CERT1iRCAT10NSTAlEM N :' ;- �
005
��e) � that on the 15t day /o�f M roh, 20_
I(VJ occupi s our principal pla of residence Ih Ilowing described r property (or which a Homesiead Property� iYrS �y daimed:
� V
� I(We) owne ❑ Are buying under contrac GBSON COUNTY AUDITOR
� Have a benefidal interest in lhe entiry ihal is liable for the pmperty taxes on the property and that owns the property or is buying untler a contract.
� _
If buying on contract, Fee Simple ownefs name
RecorEefs ofice whera contraC is recorded
Rewrd numDer
Page
.-....,_.. , . ..-r- rvs a-_^a: —� . .'_.-.
. -fp_.. .. �.�_ :.L.
=i=�. f t.. �.� - �s,� -, � =PROPERTY DESC TION�•- : �... • � y , .o-Y '
County To.vnship Tacin di ri dty, town, tOwnship)
P rcel n ber LegGal d�e�Gon^ n - ' Is Ue pmperry in qu tion:
�� � L/ G�Q�,�Y� a ❑ I property ❑ Mobile Homo ll.C. 67.1-7)
If any portian of Ihe residential strucWre w the Wn0 not exceeding one (1) aae that immediately surrounOS ihat s ure is usetl to protluce income, desuibe Ihe use antl portion
ot the properry utilized b produca inwme.
' '
3`T�-';::�'�,''`'.:`.>T'_�-^�..,_` -.��-..°`�BROFERTYOWNED�$YCLAIMANTiN.OTHER`COUNTIES'� - '�'.�': '^+ :-1..rrx .-_+=- s .��..
Coun�y To.vnship County Twvns i��
I hereby certify the above statements are W e, correct and complete. Sign t 1 cl imanf
�Address (nu r an0 y�eei, ciry, stale. ZIP e) - �^
6 l% U
rt�� j� °r ASSESSOR-0SE ONLY�,�, . � � TRUE TAX ASSESSED VALUE -HOMESTEAD'' NON-RESIDENTIAL;., -
��A- �.,.a,.= t �+-'-�.;; _ -- VAI.UE . AT100%OF.TTV . �' VALUE' ._- �;t'VALUE-, - f_.�-�
rx E .ssn..`y r_
Land not exceeding 1(one) acre immediately -;'�' ,- -� -`3'�
surrounding residential improvements. (� � "' �+' �' � . �
Oiherland (p) - ._- ��
Tqal land (line 7 plus line 2) �3)
Dwellin9 (4) . - ,,.Y>• ::ts?�ii:._ - .�` .�::. . ..
Residenliel improvements or Annually _
r : . .;:..� .
Assessed Mobile / Manu(actured Hwne Garege �5) S€�� �' . . _,_ ... � .
Other improvements (6)
Tdal improvements Qine 4 through line 6) (��
Tdal value (line 3 plts line n (8)
1 hereby certify the abOVe is W e, correcl, and Signawre ol Assessor Date signed
complete.
Venlying aclion - Signawre otlwditor Dale signetl .
ybr.:rt' ' t ,�,�.?� --�STANDARU.DEDUCTIONALLOWANCE"-��'��� '� � � _ -
20 _ Pay 20
Lesser of 1/2 Homes;ead
S
vauauon or 535.000 .
SgnaWreoflwditor ' Datesigned