Homestead_Ota • 6
STATE FnRM!Me.tle !—u 1 MFISIIIIXm0.Vt11A
APrKIYrt1 BY MrOE MV¢n nrMYTtINrs]rr1 PRI,IUtm BY Tiff Dream-£YI rK rOA1 CAYER.YMr1.T FINANCE IC 6-1.1-raa.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
°
PRINCETON IN 47670 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 feud causes.hiu er tat bills for all:therefore.
• HEA 1344-2009 requires taxpayers who reecho the homestead standard deduction to verify that they are eligible to rceebc the
benefit and to provide additional identinine information necessary to allow county government'to better monitor homestead
flings.This information will be kept confidential and can only he accessed by authorized county officials.The Department of
Local Government Finance will u.e this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Q_ Ota, Tim/Iris
610 W State
Princeton IN 47670
2516
Tim Ota
610 W State State Parcel Number Legal Description
PRINCETON IN 47670-1348
26-12-07-103-001.722-028 019-01722-00 DEVINS ENLG 5 PT _
I r I I r Ir II uI rn III I I n I I 11I u I I Iu I nu I I I I r Iv Iu.I
N
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
I 01107V( 12x_0`ED
Ge'
i
•g Addles.;fmardstrandstrectraiGestatz •r rmproperty sindiZIPica44)-------- _ — — n_Sn :ns p address __ _ _ _ --
(040 cc) c5 7Gt (,
Spouse First Middle Lash citr.m(ft7,1ku
Mailing Address(Number and street,city,state,and ZIP code) one as property address
(C) �. SFr a ncsl,f, Ykl `�-7(97(
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 maybe liable for back taxes and substantial financial penalties.
Owner I Sign I e
sk•
w
I
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
♦ � � Sfate Form 5673 (RS / 10-01)
� Presaibed by Ihe DepaRment of Local Govemment Finance
INSTRUCTIONS: See revarse side /or (Irng instructions.
FORM
Ca `
DEC 3 0 200.
,I�(W,�e) upied as our principal place of residence the foflowing described real property for which a Home ead Property �� re'd'rt ts.fief�re,B d med
ld�i (We) owned ❑ Ne buying under contract . �
,Have a benefidal interest in ihe entiry Mat is liable for ihe property taxes on the properry and ihat owns the propeRy or is buying under a contraG.
If byv�g an conVact. Fce Simple ownefs name
Recadefs ofim where contract is recorded
�C��'� �s�en,rra������iSwf=s'%�L�}P�
Caunty � Tonnship
H eny poAion of
W the MOCeM �
� ` Q O al deuaP�on /�
�C/�.
rdenUel strucWre w Ne land nd esceeding one (1)
b Produce it�Wme.
Is the
Recard number . � Page
[�Real property ❑ MoDiie Homo (I.C. b1.1-n .
that struGUre Ls used b produce inwme, Oescribe the use end portbn
9—� Ir :