Homestead_Nease STATE FORM S)569(RUB-IO) TREASURER FI RM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 106-I.1-22-8.I
IMPORTANT NOTICE TO HOMESTEAD;PROPERTY OWNERS;;
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
'°duction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
causes 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 count}, officials. The Department of Local
Government Finance will use this information to create tools that will help county-officials eliminatt -
homestead fraud. C�
e i'.PARTIT€PROPERTY-INFORMATION K :; �' ,A,, : ;; °:?
Tasdarer Same Pronern Address, Stale Parcel Number Leval Descriofion:
Gary A Nease 207 S BOULEVARD PL 26-12-I8-304-000.793-028 BROADLEIGH PARK 93
PRINCETON IN 47670
Complete and return to: • I l IERlIETIEV1CS1T111131, 1l ET. ®1(.7(1111131111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 Y
's=+' :' ?` PART 2: TAXPAYER INFORMATION xk
Owner 1 First Middle Last
Masmg Address(comber and street Pty.state and ZIP code) ��e same as property address
;007 006 t6/_ igteuc et-i7oX1 TA-1 �/ 7 6 7
Middle - • - Last
Mailing Address(comber and street,city.state and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number(last S digits) awe Other(please specify in Pan 4 below)
■■■■■ ■■■■■
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 1 Signe a Date
fprAilv'SPART 4: ADDITIONAL INFORMATION
•
FILED
NOV '5 2012
r,pen•. rnl II•V AU..
e��'� t\ CLAIM FOR HOMESTEAD PROPERTY TAX � YEAR
,'� CREDIT/STANDARD DEDUCTION r�� � ���
�� Sta;e Form 5473 (R2 / 5-92)
`� uu 7f1(1[
INSTRUCTIONS: See reverse side for tiling instructions. ���� ' E �3.TJ
CERTIFICATION STATEMENT S
� �we / /� �/ AUDI
I C:r ��2. �f /�. � I ERSc certity that on the 7st day ot March. 19 5�
) occupied as our principal place ot residence the following described real pwperty for which a Homestead Property Tas Credit is hereby claimed:
I(We) owned ❑ Are buying under contract
❑ Have a benefcial interest in Ihe entity that is liable for the pwperty �axes on the properiy and ihai owrs ihe pmperty or is buying under a contrac�.
� CONTRACT RECORDED
II buying on crontracL Fee Simple owner's name
Recortler's oXlce where con;ract is recortled Record number Page
PROPERTV DESCRIPTION
Couniy I TownshiD Ta.ing diStriCi (a�/t�.{o�m. ;ownship) /
�!/3Se../ T .2ii✓CBToN
Pa¢el numDer Legal tlescription �
n /9-0 0 793-00 ��2o.,o�e,�,� � a,� 9.3
I: any portion ot ;�e residential strucwre or ihe land not e.ceeding one ( t 1 acre thai immedlarely surmunds that stmcmre is used ro produce income. tlescribe Ihe use and potlion
of the pwpetly utilized lo protluce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �
Coun;y Township Counry Township
�^eby cenify the above statements are true. wrrect and comple[e. S� na•r oi cia�man
Adtlress (numberands(reet. ury. s7a(e. ZlPcode) _
aoo P�y �ic�.�� � 7G 70
ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VAIUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately I, � I , I
surrounding residential improvements.
O,her land (p) I
Total land (line t plus line Z� (3) I I
Dwelling (a)
Residential improvements
Garage (5) I
Other improvemen;s (6)
7otal improvements (line 4 through lina � (7)
Total value (line 3 pUS line � (g) I
I herBby CBrtify lhe above is tru2. cOrre[t, and Signawre of Assessor I Da;e signetl
complete.
Verifyirg aGion - Syna;ure ot Autlimr Date signed
�1
19_Pay19_ �
Lesser of V2 Homesteatl I
Valuation or 52.000 S
Synature
ALLOWANCE