Homestead_Jones STATE FORM 5-.;69(R38.10) TREASURER FORM TS-IA
APPjIOVED BY STATE BOARD OF ACCOUNTS,2139 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1 22-8.1
ri:147 °' IMPORTANT NOTICE TO HOMESTEAD PROPERTY-OWNERS 4 13'5° '.44,'
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
Sid uction 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.
vs; ^: PARTI: PROPERTY INFORMATION t L_try I r r :141. ' r -,
Tamarer Name Properly Address State Parcel Number Legal Description:
Carmen C Jones 908 VIRGIL BLVD 26-12-18-101-002.609-028 PT NW 18 2 10.295 AC
PRINCETON IN 47670
Complete and return to: IUliflf MENIuEMIuii D1Ul Bri ill
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
,t) "
PART 2: TAXPAYER INFORMATION - t,r 4
Owner I First ( J ( Middle Last
l ,Q,Yrnvt•P� `/O 12 11 e in-Le S
Mailing Address(number and street,Qty,state and ZIP code)
Same as property address
Spouse X g 5 .7 First Middle Last
Mailing Address(number and street,city,state and ZIP cede) I Y sa^1tl as property address
9ok \ (c f L. `i)Lvi) .
Sepal Security Number(last 5 digits) Others License/State ID Number(last 5 digits) MAN Other(please specify in Part 4 below)
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 Date
}�'• :
FILED
NOV 2` 9 2012
c.�.m
GIBaOry COON I T AUDI I0K
n.
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Slate Form 5473 (R8 / 4ai)
Prescribed by Na Oepartment W Local Govemment Finance
INSTRUCTIONS: See revarse side /or filing insfructions.
FORM
HC10
�'���_��
YEAR
I(We) V WV / RK/{'` certify that on the 1st day of March, 20_
I(We) occupied as our principal place of residence lhe foll g desaibed real pmperty for wh a Homest Pr�erty T��red(t�is hereby daimed:
❑ I(We) owned ❑ P,re buying under contract ���`�-f �
� GBSON COUN7Y AUCiTOF I
� Have a benefidal interest in Ihe entiry tha[ is liable (or the property taxes on Ihe property and that owns lhe property or is buying under a wntract.
If buying on tonVap, Fee Simple ownefs name
Recortlefs ot6ce where contracl is recorded
n �y
ofthe
County
Tavnship
-�oY-o� � - �'t r/(�� / �'-
n of Me reaidenUal struc4ire w the land nd eaceedinp one (1) acre thet im
rry Wlized tc produce income.
Township
1 hereby certify the above statemants are We, corred and compiete.
�d�,�ess (N�nber ard sbee; ciry, sfa�. LSt44de) : ��
Land not exceeding 1(one) aae immediatety
surtounding residential improvements.
O�her land
Tdal land (llne 1 plus line 2)
Dweliing
Reaidentiel Improvemante or Mnuelly
� � � �� H� Garage
Other improvements �
TUaI improvements (line 4(hrough line 6)
Tocal value (line 3 phs line �
I hereby certi(y the above is we, correG, and
complete.
Veritying action - Signature ofPUaiWr
i�)
1Z)
(3)
(4)
(5)
(6)
(�)
(8)
Signature of0.ssessor
Tacing aistrict (ciry, town,
Is
surrounds that
County
o( daimanl
Racord number � Page
i queslion:
Real D/aGeRY ❑ Mobile Homo (I.C. &f.1-n
ire is used b produce income. Cescribe the use and portbn
Data signed
Date sgneA