Homestead_Memmer (5) STATE FORM 53569(R3/8-10) TREASURER FORM TS-IA
APPRO3.'ED BY ST.'TE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6I-1-22-8.I
IMPORTANT NOTICE TO'HONIESTEAL!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
0.. auses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
.Ward 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.
; _; ` PARTI:, PROPERTY,INFORMATIO\ - ' ;c
Tatna'er Same Pronertv Address State Parcel Number Leeal Description:
Jill R Memmer 412 S SEMINARY ST 26-12-07-103-002.292-028 PT SE 7-2-10.16 AC
PRINCETON IN 47670
)
Complete and return to: IllII0O]DD0IDI(11mlmlf0MIIEi EE111IQDVIII®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 I LL Ill ]ILI LI 111
r:'- _ '.. . a .e-. . . : . ,, PART T.,TAYPA\ER;INFORNIATION • : •
Owner I � First Middle /-(J�II/�',w�,,^,t��M� Q,� Last
Mailing Address(number and street,city,state and ZIP code)
--I Same
� ' — as property address
``�`' `'�r� First Motile r last
Mang Address(nunter and street state and ZIP code) 1 I Same as
property address
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. --
O per 1 Signature Date
r •O . PART 4: ADDITIONAL INFORMATION - - -. - - .:`
FILED
. . JAN 10 2013•,ir
'
eiBsuN Loar l AUDITOR
a�rtn°i CLAIM FOR HOMESTEAD PROPERTY TAX
`'�"� � CREDIT/STANDARD DEDUCTION
'� �• j State Form 5473 (RS / 70-Ot)
Prescribed by the �e0arimem of Local Govemment Finance
INSTRUCTIONS: See ieverse side lor filing insWC�ions.
FORM YE R ,
HC10 �
� 6� ,
STATEMENT^ �. � _ - - -�
I(We) rti t�o [he t�o ar , 20
��I----(//VJe) occupie as our principal place o( residence lhe following descnbed real property for whiU a Home ad Pr e T is daimed:
�(We) owned ❑ Are buying under wniract e R Q 9
iave a benefidal interest in the entlty Ihat is liable for the property taxes on Ihe properry and that owns �he prd��rt� o�s+Bu��bnder a contract.
If huying on conUad, Fee Simple owners name
RemNefs olfice where wntracl
Tavnship
Legal descnption
Is the
Rewrd number � Page
�/ y Q�d �jr —[/V � I y�i Real properry ❑ Moblle Homo (I.C. 67.1-7)
if any portion of ttie resiEenUal sWdure w Ne Wnd not exceeding one (1) aae t�al immeUiately surrounds that swcture is used to produce income, desuibe che use and portion
of Ihe properry utilized m produca income.
Toxnship
I hereby ceAify ihe above statements are We, covect and wmplete.
(number and strpet, ciryrcJata, ZIP code)
County
� �lAS ES��R �S aN Y'r � �- x � �-b ��y�'� `3 TRUE TAX �, � �ASSESSED VALUE .HONIESTEADt �� M✓jNON-RESIDENTIAL° �lt,
. �:�� 'c�.i� -t�°�.i:`.�d�_.y�.�i��' .?,� y-��.VALUE:_ -,AT.-t00Y O�F:TTV . VALUE.`'..s� :#a�� � �..� VALUE "�;,:e �eT:v.
Land not exceeding 1(one) acre immedialely -_ '�T�j�" �#+ y�.t,� z�;-Ry '�-
suvoundin residential im rovements. ��) 'k `�' �`�`�' i=�" � L�`�`x"-�
9 D -���.�..�_<�...,_r,.�. i.,
Other land r ti';`n"5u � < � '
�z� ,t;�x�v'va' ._ ,$'_�`_�'�_'
Tdal land (line 7 plus line 2) (3)
��' T�,t[�. ic Sj-�"fr:7��' r --:
Dwelling (4) � �� { j !�� z ��� ;�
Residential improvements p'
i���; ���x.��N-�, �e� � <s i '
'i'�.
Garage �5) �:r....'� �� i?. ' _°..r:
r...- Ta:.t*.u>F=4,.:�i.,��-_...;'1.
. .,: ->,-�Y-"�'y`.� r� Y
'>3'r._ : :.
'� i �
Otherimprovements (6) �� =x' ;. �,�;�., `�a;
_ - ..i,='
TUaI improvements (line 4 tb�ough line 6) (7)
TUaI value (line 3 plus line n (g)
I hereby certi(y lhe above is We, corted, and Signamre ot �ssessor Date sgned
complete.
Verifyifg action - Sig�Wre ofNitlitor Dare sgned
�-`=�-c-`'.�,��-� �-a%�--a`,``r"��rr `� � -=`-i==: i3r��i"�.-,,.�STANDARUDEDUCTION��ALIOWANCE ._�".-r.�> i"✓,. �''..�-,s�-�'�'' ��' �"'-�'�_ �'�•.�'1.3r, ��_-.
20 _ Pay 20 _
Lesser of 7/2 Homestead
ValuaUOn or 56,000 S
Sgnatura otAuditor Dale signetl