Homestead_Richardt STATE FORM 53509 OW 8-10) TfEASL'REM FORM TS-1A
APPROVED BY STATE BOARD OF ACCOUNTS.AN PRESCRIBED BY THE DEPARTMENT OF LOCAL COVflNMEVT FLVAV(S.Ie6-1.1-]]A.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNER$`
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial,there is more incentive than ever for homestead Gaud.Homestead fraud causes higher tax bills for all;therefore,
HFA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
FILED 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.
PART I: PROPERTY INFORMATION- -
APR 192011
Taxpayer Name Location Address
C.J.Ir V
-Richard', Brian K
601 Johnson AVE
GIBSON COUNTY AUDITOR
Princeton IN 47670
1040
1111011UBIEI01111 II EiIDI10 I _mI11111EIDII00110IIIDIII111 BrianKRichardt
601 Johnson Ave •
PRINCETON IN 47670-3151
I�II�II'I'I��III'�i'II��IIIIIII"I��"I'I�I�'lll�llillllllll'lli� State Parcel Number Legal Description
26-12-06-203-000.122-028/'DIKE ENLG SEC B OUTLOT 44B/44 C-1
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2: TAXPAYER INFORMATION
•
• , _. I First , Middle - L Last•
Mailing Address(number and street,city,state,and ZIP code) Same as property address
Spouse First , Middle - Last -
'Mailing Address(Number arid sweet,city,state,and Z.IP code) -"-?' D•Same as property address —-- — --- — - -
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
I I I I I I slat
PART 3:CERTIFICATION
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 thai,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial fmancial penalties.
Owner I Signature Date
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDR/STANDARD DEDUCTION
ti slale Fortn 517J (R7 � s.as)
Prearnbe0 by ihe Depenrr�ent of Laal Gwemment Finanm
INSTRUCTIONS: See reverse sFde /or fi(ing instructions.
�
FORM Y�
HC10
� lWe) 1��-J � y�/ �-�/ CL-u v� certify BiaT o� tl� �1'si day oi March, 20_
I(We) occvpied as our printipel place oi residence ihe fo0owing dcuribed real property tor whirh a Homestea�.Q{operly��Credil is hereby dairr�ed:
❑ � i�) � ❑ Are b � /�a �
uym9 under mntrad c C/
�Have a benefida! interest in tl�e entity that is IiaWe for C�e property ta�ces on ihe property and that ams �e prO� t�To� i��iTi�Bnder a contract
rc buyug om m�tract, Fee Si�le o,mefa rreme
R�rdels ot6m
cau�ry
Parcel
(cdh: rown.
La Uie
Recard number � Pege
� � poperty �„J Mohib Fbma (I.C. 61.f-n
H a � n of Na rasideNal s0u9ne w the Imd nal mmeeding one 7) t�t onrtrt��dd�q artounds Ihat is usetl b produoa ewmie. dmcribe the use and por6on
of in rty wiGmd m produce uimne. / 1(�,�//. �•.�,��/ /7
0./ .r�.u' f
o?�-ia-o�-�o.�-ab.�aa o�a'
���-'h'L�f''e4'4Pmi"�'���.tc"�z"��±�k`.�1;'�11iNfiST.�ws�k�i,A��'i�,:l:c'STANDARD'�.DEDUCTION�'AI:L"OWANCE?�3D�z�:�,tzR9?:t�`o`�.�:'t�fil�!.�/.�.�:b�. a'{�'iS��.+ei��n':��.'�>;�`�..��.�'k`a'
� 20_Pay20_
Lesser W 12 Homestead
Valuatim or f35,000
S
Si�hue otAuEitar Data signed