Homestead_Portee (4) J
•4
4.7"%441:14, STANI'DARD /SUPPLEMENTAL DEDUCTION. . FORM YEAR
, .' State Form 5473(R1216-09) ,/i,JANr0,5 2011 HC10 - ,
•.- ,-��V Prescribed by the Department of Local Government Finance /i IY O L
C.Qt - ' -.0_ - 1
INSTRUCTIONS:See reverse side for fling instructions. ,t V C .1....r.r
ill CERTIFICATION STATEMENT
I(We) certify y that I(vvvvv��mrma)�o11cc, led as my(our)principal
place of resident- or am(are)buying the following described real property for which a Homestead Property r rd Tax Sta -b isryereby claimed
under contract on the date this application is filed, (date of filing): \
• GIBSON COUNTY AUDI
TOR
❑ I(We)own ❑ Am(are)buying under recorded contract
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
It buying on contract,Fee Simple name 0 . /� /
Recorders office where contract is ed /f1,V��'I{ �(—J N/)/AC�fCj�A Vn Record number Page
PROPERTY DESCRIPTION
County ���,,/ • Township Taxing district( , •.41 rp / �- J
�P r//rsc,���t nuymbe)r / � �•J�oL.efg�al e�( ption I Is N-a property in question: �lnually {f�
l(y/p--/��si/ 1...��•`J `� V )I RL1rQ7 Real property ❑ Annually assessed nrohle home(/C 6-f-f-7)
® If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrou that structure is used to produce income,descnbe the use and portion
of the property uttered to produce income.
•
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County nn Township
I hereby certify the above statements are true,correct and complete. 5igaature 01�mam dz •
Address(number end street,city,state,and ZIP•••,) \7/.. //l// �.(,/,l/
//ZS' j. /z ('o4/r (S hill/C6/44/ _ - 4rG R/
ASSESSOR USE ONLY TRUE TAX VALUE l ASSESSED VALUE HOMESTEAD NON-RESIDENTIAL
AT 100%OF TTV I HOVALUE VALUE
Land not exceeding 1(one)acre Immediately ------ n a
surrounding residential improvements. (1) ? j` .e
T..
Other land . (2) {_s
Total land(line 1 plus line 2) (3)
Dwelling (4)
i r1.VIF-
'
Residential Improvements or AnnualAnnually �
Assessed Mobile/Manufactured Home Garage
(5) " 7F'-w*-s _
Other Improvements (6) '+ :fa? } 4i
,
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (B)
I hereby certify y the above is true,correct, Signature of Assessor Data signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
® STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Noh/Nstandirg any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that is $
not assessed as real property or to a manufactured home that is not assessed as real properly may not exceed
if(la)of the his of the mobile home or manufactured home.
5 tgpo PuQt)o n , Lgoffrut/L(t-- -- oats signep(rtaln`jh,day year)
STATE FORM 53569(R3a-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.I-22-8.1
15‘4:::f:4;,:!., IMPORTANT NOTICE;TO.HOMESTEAD`FROPERTY:OWNERS 1 '
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
auses 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.
S'- ' '.4:f'.` P ART 1::.PROPERTY INFORMATION ` %•'" '="- a "a' - _ - -'.Cci,• , ,
Tasnaver Name Proper,.Address Slate Parcel Number Leval Description: ,
M & S Properties and 1125 S STORMONT ST 26-12-18-204-002.580-028 SS ADD 268269
Contractors LLC PRINCETON IN 47670
"IC
Complete and return to: 0,0 - IIIIIII f P.,IImu1u [IIA 1[IIlafllllll llVED E2EIllIll�lll_ -
eta nauauJUUUUerua4ruw Vie t.euuunw
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670•' rte': }a :!. i PART 2: TAXPAYER INFORMATION . . •« #A h -5h'
Ovmer 1 First Middle Lest
A/cOle . Ld 42 address
Mailing Address(number and street,ti)ty,,s state Tand
�TZIP code) \,�f' //J////_7 / y/ / / ss Pro �J
//2S rT Sk,cmoA// `–�G / / ,/LFe6/Q/V J J Same Vth `/0
cause First Middle Last
Mating Address(number and street,city,state and ZIP code) I I Same as property address
Social Seaasty Number(last 5 digits) Drivers License/State ID Number(last 5 digits) n.• Other(please specify in Pane below)
1. ."; "%;Pr 2Ct", ■■ t.1111::‘,.2_PART3:_CERTIEICATIO u Y viii ta" vfi'Av
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.
Ovmer 1 Signature Date Telephone
\ \ —f— \ c
Spouse Signature Date Tel
LIED
,:t; 1, . ,.H. ,.,7. J . y.. PART-.4;.ADDITIONALINFORMATI i N, . 'sr TL 141-InQIWr d
.0 \ 7)\—)--
I 1 .C`se "N-
i) 1, .t� , 1 `i v-'a-�i - _ - a. • • 2. I O .
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INDIANA � ES DISCLOSURE FORM SDF ID: � t Pa e 2
�rD'.'�P,REP,'ARER':^'�i;�°F�=�?�'z�'-'�'�'y.i.�.t����i�?., �'_`�'�.`_.,��'�.'!:;"r.Zi�c:_`��t��.�-v?sf_''t�.-'^l.n,'�: rc.�.".ii.�.ci�fl..X`:�Y��S'','i�a'.':�.�:,E;'.
Rav M. Drutev Attomev No. 4759-26
Prepvrer of Ne Sala DBNasure Form Ti[le
-05 N. Church Street, P.O. Box 146 Law OKce of Rav M. Drulev
Addras(NumberandStreeQ Company
FoR Branch. IN 47648
�E?SELLER$'.GRANTOf2.S t�eF"�.-`,'-�-�"�..n�.��;'`r'Y"'.-�.,.{_vc�r��"'.�'�..?.�.��3w�eS'��'^�..`;:FyP��`'.'`-s:r�.-ir%�a..t�"�..Y'�>�'"`%s-�..'_rF..._ ��:'-"s"g�'�z*..i:
M A S Pron2rtiPC and Contrectors L I f
Seller7-Nameosappeorsanconveynncedocument �Ier2�Nameasa rsonronv
ppea eyancedocumm[
1125 S. Siormont
Addrers Numberand5treet - t-�
� ) Addre�s(Numberand5treet)
_Prinr.eton. IN 47670 M1.�'� '�
-ve;
Ciry, Smrg andZlPCode Ciry, 5[ote, and LP lode �T
ed•`
E-mail Te(e honeNumber E-mail
Under penal[ies of perjury, I hereby certify [hat this Sales Disclosure, to the best of my knowledge and belief, is true, comect
and c pl te as re w and is prepared in accordance with tC 6-1.1-5.5, "Real Property Sales:Disclosure Act".
���m����C���•liln b L.�l f7 GV
a reo(Seller Sjgnamrea(Seller .•
M 8 S Pronerties and Contradors 1 LC n�tmi�mn
RinredNomeo Se1f 5' nDa[e MM D Pn'ntedNameo Shcer � SI nDare ,wx n
�_,—_ '_ .— _._ _ __� - ____-_' __ —_ _ _ '�___
,�EaBUYER-�S`.GRe�NTE �:+'APPLICATIONiF,OR+P,ROPERT�* '-= � • • -'"�.�t}' _,.,,, �
Y TAX�-.DEDUCTIONS,_IDENTIF,I:'ALC�ITEMS;THATI/1?PLY;,,, 5�,:�`'�'';5r»3��.'3-,'
i P •
Buyerl�Nameasappmrs ronveyvncedocummt Buyvs2-Nameasappevrsomm�veyoncedocummt
mont Street
�AdEras /Number ond Strreq Addrev (NUmber anEStreetJ '
°rinceton.IN 47670
�� E-mail Tefe honeNumber E-mail
THESILESDISCLOSIIREFORMMAYBEUSEDTOAPPLYFORCERTAIYDEDUCfIONSFORTN R7Y.IDENTIFYALLOFTF{O$ETNATAPPLY.
YFS NO CO\DRIOA I YES NO COSDITION \
Q✓ ❑ 1. Will this proper[y be [he buyer's primary �✓ � 3. Homestead
residence? Provide wmple[e address of prima � , rgy Hearing/Cooling System
residence,includingcounty: `� Cj�'S5
1125 S. Stormont ❑ ❑�/ S. Wind Power Device �• �� 00
Addrm(Nomberand5veet) � �✓ 6. Hydroelectric Power Device
Princeton. IN 47670 Gibson � Q 7, Geochermal Energy Heatlng/Cooling Device
City, Sm[e ZIPCode �ounty
� �✓ 2. Does the buyer have a homestead in Indiana [o be
� Q 8. Is this property a residentlal rental property?
vaca[ed for this residence? If yes, provide ❑ ould you like to receive tax sta[emen[s for this
complete address of residence being vaca[ed, perty via e-mail? [Provide contact injormadon
including county: elow. Please see instructlons%'or mare informadon.
Not availa6le in all counties.)
Addreu(Numberand5treet) '/ �/�l /�Y. �v�00o?.,Sd�� �`� `" �
�/}C� Ot. (J
Ciry, SmreTJPCode Counry
Pnmarypropeltyownoronma[nome E-matl
Under penal[ies of perjury, I hereby certify that this Sales Disclosure, to [he best of my knowledge and belief, is true, correct
and comple[e as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". (No[e:
Spouse informa[ion, Social Security and Driver's License/Other numbers are not necessary if no Homes[ead Deduction is
being filed.)
�����.�
Sigmmre o/BUyerl S(qnamre o(Buyer2/Spouse
LastSdigi[sofBuyer2/SpouseDriver's State Las[SDigirsofSocialSecuriry
License/ID/OrherNum6er Num6er Lirense/lD/OCherNumber