Homestead_SturgeonCLAIM ';FOR HOMESTEAD PR , OPERTY TAX FORM YEAR
CREDITISTANDARD DEDUCTION H00
State I= 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (we) , certify that on the 1st day of March, 20_
I (We) occupied as ourlInricipal place of residence the lowing described real property for which a Homestead Property Tax Credi . t is hereby claimed:
W'-I I (We) owned ❑ Are buying under contract
ave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
-CONTRACT- RECORDED '°
If buying an contract, Fee Simple owners name,
Recorder's office whom contract Is recorded Record number Page
- W&W "3�
MtT
County
Tomnship
Taxing district (city, town. p%:g*)ipj-
-I
I k6
Parcel number
P.
Leg( disc)ption
Is the property in questis on:
1 Q =03
vii"o 'A ,
I V4;Q property ❑ Mobile Home (LC. 6-1.1-7)
If any portion of the residential structure or the land not exceeding one (1) am that immediately surrounds that s&UcWm is used to produce income, describe the use and portion
of the property utilized to produce income. L}
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MtT
County Township
County
Twnship
I hereby certify the above statements are true, correct and complete.
Signature of claimant
(number and street, city, state, ZIP code)
i STANDARD DEDUCTIOWAJ.XCIWANCE�,
iijlf �TRUEiTAX
r -
Wii6ll Bf
,T 'NO U
;Q 4: diF6iJAL4
I'�
Valu ban or .000
- ' 1VALUE"
%jTV,N
RF
1`j3 VALUE
AL UE
Land not exceeding 1 (one) acre'immediately
surrounding residential Improvements.
land
Other
(2)
Total land (fine 1 plus line 2)
(3)
Residential improvements or Annually
Dwelling
(4)
MW
Assessed Mobile I Manufactured Home
Garage
(5)
?*r improvements
(6)
tz
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct and
Signature of Assessor
Date signed
complete.
Verifying acbw - Signature of Auditor
Date signed
i STANDARD DEDUCTIOWAJ.XCIWANCE�,
20 _ Pay 20
Lesser of 1/2 Homestead
Valu ban or .000
$
Signature of Auditor
Date signed —C;�
STATE FORM 53569(R)/s-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE ICbl.l 22-8.1
�: - IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS "
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
ideduction 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.
• PART1 PROPERTY INFORMATION '
Taxpayer Name Property Address State Parcel Number Legal Description:
600 N CHURCH ST V
Roger B Sturgeon 26-13-19-201-000.128-005 PERKINS ADD 45/46
FRANCISCO IN 47649
Complete and return to: 111011[11111EICIMM011111111011MMIDEIOn
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2: TAXPAYER INFORMATION , . -r•' e-
Owner 1 First / Middle Last
R n C{ i6! CrdLec� -57Gtrq e-oto
Mailing Addr s (n r and street,city,state and ZIP code) I I J
/r t Lame as property&wren
O 60;r 421 jvad aAare%n $t /rape,j z 7t) '/7G4'?
,
apause I First - Middle Last
Dcbrvi \-1 . STargro10 Z-no_ 0 S7ur3 PO 10
Mailing Address(raanber and street.city,state and 4j3 code) 0,-01 Same as propeny address
P.o out, lob) (i ha Chum. gri r r4 .Ict5Co - 4/74.y9
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 1 Signature Date
n' ?'t -•rtx tK-PART 4:ADDITIONAL INFORMATIOIVs;;r.,eJ_n._ . ?,„„x Oµ; s-«•r
a
•
L Y
F I L. 14, D
Nov 7 2012
GIBSON COUNTY AU=".TOR