Homestead_Price (3) STATE FORM 53569(8315-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I I-22-8.I
:r IMPORTANT NOTICE TO HOMESTUAD,PROPERTyADWNERS;MMIN
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
auction 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.
v .-,;(:, „txY3T -:.;-...4... :1 PARTI: PROPERTY INFORMATION-4e "' tt ,--. �',: n
Tasnaver Name Property Address State Parcel Number Leal Description:
1606 E BROADWAY ST
Larry V/Jackie.L Price 26-12-08-203-001.991-028 DIKE SUB DIV g II
PRINCETON IN 47670
Complete and return to: 1iffill 111i19➢![IpIIfpQI1L91pI11111M1f1Mflglllllll
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
L PART 2:TAXP -YER INFORMATION.-'= _ ,„14 %
Owner 1 First Middle Last
�AL_ki
`��^�� � CLAIM FOR HOMESTEAD PROPERTY TAX
i
���� CREDIT/STANDARD DEDUCTION
�%'State Form 5473 (R2 / 5-92)
INSTRUCT/ONS: See reverse side /or filing instructions.
STATEMENT
FORM �YEAR
HC,O �
_ ��a ��,._�
i) � ..-. '"�jy�,',�,,�,,j ��'�' _ certify that on ihe 1 S1' ay of �r� 19e�_�
') occu i d as our principal"place of residence the following cribed real operty for which a Homesiead Property Tax r i i eb
I(We) owned ❑ Are buying under coniract
Have a beneticial interest in the entity ihat is liable tor ihe property taxes on the property and thai owns the property or is buying under a comract.
CONTflACLAECORDED ��
If Wying on contraC6 Fee Simple ownefs name
Recortler's oflice where contract is recorded Record number Page
County
- PROPERTY DESCRIP
1' ^ Tarting is(ri i( fY, foWn.
Parcel num6er Legal tlesc n•
Qlq-o199) - �,.�hA. .�.�- � .+) i)
If any portion of the resitlential structure or Ihe land not ezceeding one (7) aae that immediately surrounds that structure is used to praduce
of Ihe property u6iized ro produce income.
the use arW ponion
ASSESSOR USE ONLY TiiUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL
- VALUE VALUE VALUE VALUE
Land noi exceeding 1(one) acre immediately �
surrounding residential improvements. (��
Otherland (2�
Total land (line 7 plus line � (3)
- Dwelling (4) �
Residential improvements
Garage (5)
Other improvements (6) .
Total improvemenis (line 4 through line � (7)
Total value (line 3 p6s line 7) . (g)
I hereby Certify lhe above i5 true, correct, and Signamre oi Assessor Date signed
complete.
Veritying action - Signature ot Auditor Date signetl
. \
19_Pay19_
Lesser of 1/2 Homestead
Valuation or 52.000
STANDARD DEDUC770N
S
Auditor (` (� `� I Date� r,sy�i _ned.Q�
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