Homestead_MastersCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION Nc10
t - State Form 5473 (RS 110 -01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions. T-9 7 V 171 T71t\
I (we) I- )) UMQo11 1 1,13 N OSl n certify that (Mk 1st ayg@*ch, 20—
,,11..,((W(e) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit its hereby claimed:
!!J 1 (We) owned ❑ Are buying under contract / y % "!�^ ;l
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pr`oo ty or is ;'il ing under a'contract.
lildJVfv 1, 1. J �t J. vn
' +_CO_NT RAC _T• ,.RECORDED's
If buyt g on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
��rr`: Ana.`.�,.�dr- .'E�- r`'af��';s��-
OTHER "COUNTIES'IFs�..�„- '+���r..._ens"'- "�`�`°f':
�PROPERT ,YCESCRIP,TtON•�Lis��;�e` sr�a�?�g°_;''_3i�°;��-f'
County
Township
hereby cerfiy the above statements are true, correct and complete.
Taui ,ifict (tiry, town, township)
jt@r number J�
U — V
Legal _deescriptionn,,
5 O w
-
ac)— a
Is Vie property in question:
Roal propomy ❑ Mobile Homo (I.C. 61.1.7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income. 31
-3- o- off- 67 -��
F= `s,..,- '�,�a�.rrc^ '�°+r�.,�v��. -.Z` PROP.ERTY�OWNED;BY.CI;AIMANTiN:
OTHER "COUNTIES'IFs�..�„- '+���r..._ens"'- "�`�`°f':
County
Township
County Township
hereby cerfiy the above statements are true, correct and complete.
Si aim
Address (number and street, city, state, ZIP code)
' � r �'' - - � g
qtt � ASSESSORlUSE ONLY. . _;
TRU NC
.,�f„�_ypLUE _ �„
ASSESSED VALUE
,ATz100 %TOF'TTV
NOMESTEA6r
W VALUEE
` ` ONNRESIDE ----
e, I . =yA�UE �c
land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)I�
''5=q
Other land
(2)
it
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4 )
r k x 4
Garage
()
Other improvements
(6)4
tr. a
14
NEW
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(g)
I hereby certify the above is true, cored, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
20 Pay 20_
Lesser of 1f2 Homestead
$
Valuation or $6,000
Signature of Auditor Date signed
STATE FORM 53569(R3B-I0) TREASURER FORM TS-IA
APPROVED at STATE BOARD OF ACCOUNTS.21p9 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I_I-22-S.I
Y. IMPORTANT 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
',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 county officials. The Department of Local
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
- , PARTI o PROPERTYINFORMATION t?r _ ' ; =l
Yammer Name Property Address State Parcel Number J.eeal Description:
William A Masters 214 S DIVISION ST 26-13-20-103-000.167-005 PT SW NW 20-2-9.31 AC
FRANCISCO IN 47649
Complete and return to: l0uhl uuElllHUulffJ.ulu.uml13113fE(1311I1Iu3IuuI0Vll
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2: TAXPAYER INFORMATION , r '
Owner 1 First Middle Last
(,(/fl;Awl Ai6P.-I- /12As-
Maiing Address(number and street,city,state and ZIP code)
Same as p t:merry address
/\►
Spouse First Middle Last /
(Y) lehele O1As4ers
Mailing Address(number and street,city_stafo and ZIP code) l Same as property address
� r !t_ ° ,..
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and cored 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 Signature Date
/
s r'PART,'Q: ADDITIONAL INFORMATION-'" > t,. t' '
FILED
• NUV l b [U1[
GIBSON COUNTY AUDITOR