Homestead_Jefferson STATE FORM 53569(R3/5-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6.1.1-22-8.I
t . IMPORTANT NOTICE TO HOMESTEAD PROPERTYOOWNERS
- - -
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
�
iuses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
sia dard 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 eliminat-
homestead fraud.
PARTI: PROPERTY INFORMATION
Taxpayer Name Property Address Stale Parcel Number Levi Description:
Lawanda M Jefferson 722 E BROADWAY ST 26-12-07-204-001.644-028 NS PT LOT 3 R3 PT SE 7-2-10.243
PRINCETON IN 47670 ACtnII1
Complete and return to: _ EllOD�KIRI IIMUM Hfl!�f'9QJ®uhEu I�llNNi
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
_- _ . PART 2:TAXPAYER
Owner I First Middle Last
LAW Adit MA- -f E v e-PCE(2-,Or''1
Matting Address(number and street,abr.state and ZIP code)
Same as property address
z BP-04-'6 UM-el 101-111 n Jfl 417676
First Middle Last
Mailing Address(number and street,city,state and ZIP code) Same as property address
Social Seventy Number(last 5 digits) Drivers License/State ID Number(last 5 digits) stas Other(please specify in Part 4 below)
_- PART 3:CERTIFICATION_ •
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.
Purer I Lure Date
- - ' PART 4:ADIIITIONAL INFORMATION
•
aasr
• -DEC 28 2012
GIBSON COUNTY AUDITOR
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Stete Form Sr73 (R6 / 4-03)
Presafbed by Ne DepaRmant af Local Govemment Finance
INSTRUCTIONS: See reverse side for filing ins8vctions.
IJ� FORN,,�
� HC1'��j
�� �
i�
��e) �� �� certify Ihat on the 1 st day of Mar°�,, 20_
I(VJe) occupied as our principal place of resid n e ollowing described real propeAy (or which a Homestead Properf� Credit� hereby daimed:
!a� ,CS�
� 1(We) owned ❑ Are buying unde ntracl GIBSON CpU
' Have a benefidal interesl in the enGty that is liable (or ihe property taxes on the property and that owns ihe property or isbuy�rTg�u�'a EUCVaU.
If buying om m�iract, Fee Simple owners name
Recordets olfice where wntrad is
Tavnship
�U/v
(uty, fown,
Is ihe
VI /� E)/(o7 / -"�- �'dG '�oC-/O py��IC�
If any portion of Na resiEentlai sWGure w the land not axceedinqgq ej1),7aae/�ihat immediatety surrounds ihat
of Ihe properry uliGZed tn produce income. L/l !� f.-.�L d�C �
7 / d (...tRf'
Rewrd number � Page
�, Question:
Raal properry ❑ Mo�ile Homo (I.C. 6fJ-7)
ire is used 10 produce inmma, desciibe Ihe use antl ponbn
F`s�',i.a��'�?� r�wl.��'l'�it3��.,-�t,'"�'-�,vSTANDARD:OEUUCTION�AU:OWANCE����uk��=A .`�".�w'�2."z'�z'n:s.w-�.�5_'.�"'i��`i��`-e.e�^�k
20 _ Pay 20 _
Lesserof 1f2 Homestead S
VaivaLOn w S35.OW
Signaturo oflwddw � Oate signed
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