Homestead_Jones (12) 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 IC6-1.1-22-5.1
I�LPiOt,Rail!ar\;;Ti�N,-OO T otE iT1,0 tailVIES�TiEXPIRROPEI.ZE O \`,tERS ` <i „4
Nkn»dnu I�Flrer �ma�3..l,rris.
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 ''uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
s ndard 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.
> '24';,-+11.4":- PAIM PROPERT5YIi\FOR,YIkT11N„
Taspaser Name Property Address State Parcel Number Legal Description:
Keith D Jones 636E WATER ST 26-12-07-302-001.905-028 STORMONT ADD 12PT
PRINCETON IN 47670
Caplete r,-to: ®11Omuumm�Q�O10mmQuu] 0�m®
rGIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
-, PART 2:TAXPAYER 7\FORMIATION ,,/�
Owner -464_ ® Fusl 1 Middle1 ��/��I S€? D �� v A,,{Matirq Address( and street,city.slate and ZIP code) ' -4 Sapp as property address
-5,.__. First Middle Last
• Moiling Address(nwbec and street.My.slate and ZIP code) Same as property address
Sodal Security Number(last 5 digits) Driver's License/State ID Mather(last 5 digits) axe Other(please specify in Pan 4 below)
54.4 ,':.s z_ a 'PaRTt:1 'CERTIFICATION .. I
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 L Sigre re a- ( p '
�lyplr yaNg ' �{�ILT/p� 1 _
• • AUG 6• --2012'
O 3SOP: COUNTY AUCITCR
•
��'..'" � CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTALDEDUCTION
S, State Form 5473 (R72 / 609)
�O ° PmwibeA by the Departmenl of Lool Govemmeni France
INSTRUCTIONS: See reverse side for fiGrg instructions.
, I ; 1:��4� �
� I� �
` ' ' � f li j,.r
MAY 1 2 2010
. .
i�we) cen�rv tnat i(`�5i8945RJee 4"`
place of residence or am (are) buying the following desui real property for which a Homestead Properry 7ax Standard DeduGion is hereby daimed
�un,(d�er conVad on the date this appliration is filed, (date o/�ling):
�-1(We) own ❑ Am (are) buying under recorded conVact
❑ Am (are) entltled to occupy as a tenant-stockholder ot a cooperetive housing corporation
� Have a benefictial interest in ihe Wst or the right to occupy the property under Ihe tertns of a qualified personal residence Wst
•- � •
Name of tla'unant (kga/ name)
�,th ,%� <Tones
Sodal Smray number
Sotial Secvnry number oi ciaimanCs spouse (WS( five tligRS) Drivers I'urnse I ICentiflralion I ONer number Issuing Sate
ot daimant's spouse (las! frve dgitsJ �
• ••� �
If buying am m�tract, Fee Simple avnefs rume
Remrdefs oRrc where mntract is remNeO Reoord number Pa9e
. _ � . . � . �
���, Taxnship Taring disVict ( , , township)
Parcel num6er Legal Oescnp6on I Is Ue pmperry in question:
� � Real property ❑ MnuaDy assessed rtrobile home (IC 61.7-7)
�If any ponim of Ne 2vdential stnx9i�e w Ne W�d nol erceedirg one (1 � aae that immeEia surtourWs Ihal sW Wre is used to proCUre irmne, descnbe the use and portion
of ihe property utS¢ed b pmduce inmme.
a�- ia-6�-'�oa -� /. 90� -o�.�
... . . : . .
Counry Township Caunry Township
I hereby certify the above sta[ements are We, correct and complete. S"a]QaJwe ai n '
l`
ress (numDer antl sf2e; al}; state, aM ZIP � � 1 ' .
)
� .� • �
�" • ii'. •
Land not ezceeding 1(one) acre immediately �T`^.sA � 3'x� ���"'
surtoundin residentialim rovements. ��) tlLyF�5—�-��Y}�3i" - �'0
«- ���yS4�t:.'S.
Olherland (Z) ` s.,.. "}��+:
Total land (line 7 plus line � (3)
Dwelling (4) �.,�`c��.'�s�{b•�.s{''���:e�i:
Residential improvementa or Mnualty .'. h - �j
hssessetl Mobile I Manufactured Home Gara e n��3>� ��;F '-4�� "�fi `����
9 �5) �..x .il r ,_'t�"�.r4 k6''r§,.._:
K s Y� S: '� .+yy4'.�
Other improvem¢nts (6) r� '`� .'i ^.x< z ".
Total improvements (Ilne e througA line � (7)
Total value (Ilne 3 pAS Ilne 7) (E)
1 hereby certiy lhe above is hue, correct, $gnatli� °��� �� �� (montn, tlay yeas)
and complete.
Veityi�g actian - SiBnaW re ofl�uditw Date signe0 (monN. tlaY. N��)
� . • � � � • •
20 pay 20 _ Lesser of 60% of the assessed value of lhe homestead or $45,000
No(vnlASfaMing any Whe�provision, fhe sum o/Ne detlucUOns pmvided in IC 6-f. f-7Y fo a mobde home Ihaf is g
mf assessed as ieel property w fo a manu/sftured hertie fhat is rot assessed as iael properry maY �t erceeC
me 1atl (iR) d Ne assessed re/ue of Ne mobde home a✓manufactu2d frortie.
s��wre a a,auar
Oafe signed (monN, tlay, yEa�