Homestead_Riley (7) STATE FORM 53569(8315-10) TREASURER FOR.M TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,3009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FTh1ANCE IC6-1.1-'_3-8.I
1MPORTAiNT NOTICETO-HOMESTEAD',PROPERTY OWNERS ,
,Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
• ction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
uses 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.
- PARI t:...PROPERTY-INFORMATION
Taxpayer Name Property Address State Parcel Number Leal Description:
Susan L Riley - 715 S GIBSON ST 26-12-07-403-000.608-028 SMITH ADD 3 PT/4 PT
PRINCETON IN 47670
Complete and return to: 11011DUU1111am 1l mioimuomummmmummoom®
GIBSON COUNTY AUDITOR. 101 N MAIN PRINCETON LN 47670
`= t PAR 2h; AXPAYER'INFOIL\'IA ION n _
Owner 1 First Middle Last
5 tit r Pr
Wass gdsaenunper a aty,sta�ZIP red//PP `-' / L
7 II \J L 0 �� I rre as property Address
weir
Mafng Address(number and street city,state and ZIP code) 1t�� Sarre as property address
Social Security Hunter(last 5 digits) Drivers License/State ID N er IIa4 55'7�g1� State Other(pease specify in Part 4 below)
iS� / Is
PART 3:;CERTIFICATIOY ,'� �:. ,
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 f ck taxes and substantial financial penalties. r
Owner 1 - Luis Date
( )
,-. '.". -'.PART.4:ADDITIONAL INFORMATION :'. .. - - ..
I
._
•
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Stete Fam 5473 (R614-03)
Resrnted by nie Departrnent d Loc� Covemment F'mance
� INS7RUCTIONS: See ieverss tida b A�p iw0uc8ona
� �'`'e� , ��l�l�t,�/<.C/{� /���,l��i
I(4Ve) occupied as our principal ptace oi residence the following described real
❑ I(VJe) owned ❑!ve buying under contract
� Have a benefidal interest in lhe enfity that is liable for the properry taxes o,
II buyirg m conVact, Fee Simpie ownefs name
Reco�de/s ofice whera cantrad is recaded
County
Parcel
Tamship
If any portion of Ne resitlential sWqure w Ihe land not exceeding me (1) aae Nat
of Ihe properry utitized b produce income.
County
Tawnship
I hereby certify the above statements are We, wrted and complete.
=ddress (numbe�r�l�f. dty, �tdle• ZIPc�e) 1 _ I �,
F�QRM � �� YEAR
pC,10 �
- 8 it.._/
NUV 1 5 2005
ceNry that on the
which a Homestead Property Ta
property and Nat owns the propeRy or is buying under a contraU.
Ta�ing dislrict (ciry,
County
SignaWre
Record number
Page
P�PeM in question:
f' �eal property ❑ Mobile Homo (I.C. 67./-�
I
that swcture is useA W produce income, desvibe the use and pwtbn
��'�p��'�"��"t'�'��'� '� �`TRUETA7(�-'�� ASSESSED VALUE '-� HOMESTEAD� :n`'k" NON;RES�DENTIAL4t�'{''n'
� -.,
f��t_..ASSESSOR�USE ONLY � ��� -� v ?'���UE�-��; �AT�700% OFTTV aY �VALUE � 1�� �
� a_ 3''e�.i��3'ia'°12�P'�'� ,... .ef`,F.�,' �-.M.._ .:3.�'.d+n.-...... .-..r � f.�.>. �:.VALUE'"'�-��
Land not exceeding 1(one) acre immediately ��,�"� �?-" "�„ �F �#-��'�r'���;
suvounding residendal improvements. ��� °, �, ��i'°"�� �
�i:@t"'•. �n+�= -...
_�..AJ'.-�f .-+ir'l :F.�-�v�.°'_;
Other land �2) .'-�l`���„-��� �� - .
Tdal land (line 1 plus line 2) (3�
Dwelling (4) ;�� �'t�i;� ���'�r3`��,� �
�Residertlial Improvements a MnuaOy '`��`'�`�"'r'"��"�'�'�~ �'�
'�p :•'" u zw;}�E�. r t _,
Amesaed �bb0e / Ma^ufa�red Hane Garage (5) ��,�x'�'-t�`��s�a�3;��i
� � ��
Other improvements (6 ���` 5���"}
) �3 .�.'�" ��
u 3� 1 L
Rlal improvements (line 4 fhrough line 6) ��)
�al value (line 3 phs line n (g�
1 hereby certity Ihe above is We, torreG, and Signature of Assessor Date signed
complete.
Verifyvg action - Signature oflwtlitor Date signed
20 _ Pay 20 _
Le>ser W 1/2 Homestead
vauanon w f35.000
5