Homestead_Michas STATE FORM 53569(R29-09) TREASURER FOR.N TEIAI
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1 22-0.1 •
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS o
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
llpuses higher tax bills for all; therefore, HEA 1344-2099 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.
PAR 1: PROPER IT ,'FORMA ION
Taroave-Name Property Address State Parcel Number Leal Description:
99?E Broadway 901 6 5&c' we(
William P/Diana G Michas 26-12-08-301-000.247-028 019-00247-00 HIGHLAND HOME 29
Princeton IN 47670 \
1
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2:TAXPAYER INFORMATION
Purer 1 First middle last
Millar PA v 1L ` In 1cN4 J-
MatLng Address(minter and street,city.state and ZIP code)
Same as property address
901 E ,32oilJwhy in%NC(10a/ fn/cj'otvh 9'7670 .
First Grace Middle • Last
•
bi,..), A Grace - pll 64-a
Mailing Address(number and street,city.state and ZIP code)
Sarre as property address
M
9 VI E Ior0C r.{p
LJGr-i r rtn ce Ion. . --r C( 7(„ 70
,-, ---____-.--_—
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 I Signature Date
PART 4: ADDITIONAL INFORMATION , -
p���0
e� � CLAIM FOR HOMESTEAD PROPERTY TAX
�'�E CREDIT/STANDARD DEDUCTION
�� Slaie Form Sd73 (R2/ 5-92)
,;._:
INSTRUCTIONS: See reve�se side lor liling instructions.
FORM YEAR
� HC1�'0 �j, I
� 1� 11 IfV -
�� ,,. ,�J!
��UI� = � 199�
'e) ���^' V 'j" � � 1 �,�,�,Q,p� �ipiYVriA� �, A/ .S
.lA�iiO' ceriify ihat on thp��5[Clay�t[�Ma�t9�
� occupied as our orincipal place of residence the following described�real pwperty tor which a Homestead Property Tax Credit is hereby clafined:
�(We) owned ❑ Are buying under contract
Have a beneficial interest in the entiry that is liable for the pwperry taxes on ihe property and that owns the property or is buying under a contract.
CONTRACT RECORDED � �
If Grying on convaa. Fee Simple owner's name
Recorder's otl�ce where coniran is rerordetl Remrd number Page
Counry Township
Parcel number legal tle=
�i9-t�y�-o
If any portion Ot the residential stmcmre or the land not
Ot ihe property utilrzed to protluce income.
�. Q-9S
l
�
PROPERTV
lown.
acre thai immedatety surmunds ihat s;mctufe is used to produce income. describe the use and ponion
PROPERTY OWNED BY CIAIMANT IN OTHER COUNTIES
, I TownShip �� Counry
by certify the above statements are true. correct and complete.
x�
Address (number antl st�ree�. ciry. slate. LP code)i
i� �/� / /[- �tcO.Y FioS/ �n/NL,t� N
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�
�
7ownship
6�a
ASSESSOR USE ONLY TflUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL
VALUE VALUE VALUE VALUE �
Land not exceeding 7(one) acre immediately I(' I I
surrounding residen�ial improvemems.
Otherland (p) .
Total lantl �line 7 plus line Z� (3) I
Dwelling I (4) I
Residential improvements
Garege (5) I
Other improvements (6) I
Total improvements (line 4 through line � I(� � _ I I I
Total value Qine 3 pbs line 7� (g) I
I hereby certity the above is irue, correct. and Signawre oi Assessor IDate signed
complete.
�ying acuon - Signa;ure ot Autlitor Daie signetl
19_Pay19_
Lesser of 1/2 Homestead
Valuation or 52,000
DEDUCTION ALLOWANCE
S
SignaWre o� Auditor � �\.\ ,/�/ \ I Ua[Q 4gn�.0 ^� I
1 7 l•
o �� �i � ;�.,u.i..�, io o i
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