Homestead_Tuley (2) 515TE FORM!1Y+tIC/NAN) IPESStILA PoL• :3-IA
.APPROVED By STATE wo OF ACCOUNTS.you PRISMBD)BY Mr DEPARTMENT Or LOIAL GOVERNMENT MANCE If 1-I.I-1-'4.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N Main
rt., �: Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
e�1, " '� more beneficial,there is more incentive than eser for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
j HEA 1344--2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recent the
benefit and to provide additional identifying information necessary to allow county government to better monitor hontrsread
filings.This information will be kept confidential and can only he accessed by authorized county officials.The Department of
APR7 - 1010 Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
'270a Taxpayer Name Property Address
GIBSON COUNTY AUDITOR �Beasley. Kerry
"Rob e r-tS
221 N Rsacis
Princeton IN 47670
1194
Kerry Beaslet,tober15
221 N Reavis State Parcel Number Legal Description
Princeton IN 47670-1935
ItlttlltttItIlttltttltl Itlttttttltt111lrttltl11t11111111 26-12-08-103-001.741-028 019-01741-00 S 8 R ADD 24 PT
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
Owner I . / First Last
lig Address(number and street,city,state,and ZIP code) yttBme as property address
gal H Q.:ea-v 5S
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) 0 Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) - Other(please specify in Pan 4 below)
--
sox
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 that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Sinna[Irre ,///� Date
•
�^`��„` CLAIM FOR HOMESTEAD PROPERTYTAX �
��%
��d ' CREDIT/STANDARD DEDUCTION �
��p�? i� State Form 5473 (R2 / 5-92) �
��` INSTRUCTIONS: See reverse side lo� /iling instructions. � 20p1
F �g 6 ii !
FORM
HC10
YEAR
I(We) "' N� `' certiry that on the tst day of March, 19_
1(VJe) occupied as our incipal place of residence e fol owing described iAA for which a Homestead PropeRy Tax Credit is hereby claimed:
❑ I(We) owned ❑ Are buying under contract �.� �� —1� �
❑ Have a beneficial interest in the entity ihat is liable for the property taxes on property and that owns the property or is buying under a wntract.
1
CONTRACTRECORDED�
onconvatt,
name
f/ —av
,itlential structure or
produce income.
rereby certify the above statements are true, correct and complete.
Atldress (number and s72et, ciy, stafe, ZIP coOe)
�-I IU ���iS i�rine��n�uJ �16�0
ASSESSOR USE ONLY TRUE TAX
VALUE
Land not exceeding 1(one) acre immediatety (��
surrounding residential improvements.
Otherland
Total land (line 7 plus line 2)
Residential improvements
Oiher improvemenis
Total improvements (line 4 through line 6J
(2)
(3)
Dwelling (4)
Garage (5)
(6)
I�I
Total value (line 3 plus line 7J
I hereby certify the above is true, correct, and
complete.
Verifying action - Signature oi Autliror
79_ Pay 19 _
>s�r of 1/2 Homestead
V�n or 52,000
�8)
Recortl number
i
hat struc[ure is used to produce income, deudbe the use and portion of
IN OTHER COUNTRIES
ASSESSED I HOMESTEAD
VALUE VALUE
STANDAflD DEDUCTION ALLOWANCE
�
NON-RESIDENTIAL
VALUE
signed
signe/d
(p^O�