Homestead_McCullough STATE FORM 53569(R318-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT.Et.'ANCE:a-1.1-22-8.I
,. 3 » " I M PORTANT NOTICE TO'HOMESTEAD'PROPERTY:OWNERS
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
s._.,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 eliminate
homestead fraud.
PARTtp'PROPERTY INFORMATION 1
Taxoaver Name Propels Address Slate Parcel Number Leal Description:
Michael S McCullough 528 S GIBSON ST 26-12-07-403-003.028-028 CLARKSVILLE 6 PT
PRINCETON IN 47670 ttitlIlI to
Complete and return to: I11[11I0ll]D�0001(1]�I111QO01lffll®m110��I0111)1111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
' PART 2. I AXPAI'ER iNFORSIATION
Amer 1 First
Mailing Address(number and street.city,state and ZIP code)
.me as property address
5012 5. G ;650,4 Sl-. P( �IC�\ ° TN 4-1i610
NJ
First Middle Last
Mating Address(number and street,ary,state and ZIP code) I Same as properly address
Social Security Humber(last 5 digits) Drivels License/State ID Hunter(last 5 digits) 1 state Other(please specify in Part 4 below)
_ PART 3: 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.
(Tyner 1 Signature Date
�
, _' CLAIM FOR HOMESTEAD PROPERTY TAX
° CREDIT/STANDARD DEDUCTION
� I Stata Form 5'73 (R6l d-03) �
' Preaaibed by Ne Department al Local Gwertunent Fnance
INSTRUCTIONS: See raverse side tor filing instnxtbnt.
FORM YEAR
HC10
i,
t
':�'... ..s- n== �,y .. '�`+ � _ , .�:• . � �:%..=7:{:GtKTIFlGATIONgTATEMENT � ^.l.r' . � ,. ;` - � r � c.:� - t .:: ..�.;��.
.C_^:_ . � - ., ..
i(v✓a) �� 1C�1 G e � rn l L. I I��5 h certify that an the 1 st dey al Marc�, 20
I(We) ocwpied es our prindpal place ol residence Ne �ng described real properry Iw whiUL e Homestead Property Tmc Cradit Is hereby deimed:
� I(VJe) owned ❑!ve buying under contract ��¢ r F � Q� �"�x„ r+ �
11 � I �
. Have a benefidai interesi in Ne en�ry tha[ is liable for Ihe pmperty lexes on Ne property and �hat owns the property or is buylrg under e conVact.
If buy4q m conVep, Fee S4nde awnNS nema
RecorOeh o'ka where convaG is recordeE
County
rart.smp
I/ eny ponim W Na residanoal itru�ra w!he
ol Ne praperry uUlixed W proEUCa incane.
IRecortlnumDer IPeOe
�:�ESC PTION � -. : r � i':"'?; -:..a��_-"n
Ta�in Ci tricc (�Y• fown. fo�M'D) ,
`ilM L�O OCJyL)
Is �he poparty In Quastlon:
(1 � aae Net muneCiatey curtounds
County Twvnshlp
�. I hereby ceNfy iha above stetamants era We, cortect and complata.
�'Eress (numDer and weef, dry, sfaro, ZlPCOde) �
�
❑ Modle Home (LL. 57.7-n
:e incoma, Oastrihe IAa uu anE patlon
� I
20 _ Pay 20 _
Lesser of 72 Homestead
Valuelion w $35,000