Homestead_Thompson (12) STATE FORM 53569(R311-I0)
TREASURER FORM TS.I I
APPROVED BY STATE BOARD OF ACCOUNTS,20e9 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1�-B.I
IMPORTANT NOTICE TO HOMESTEAD PROPERTY,OWNERS -' r`t`e•
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction 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.
:P•177 .5 PA' I: PROP R INFORMA ION t , a ; !-,-;
Taanaser Name Property Address State Parcel Number Leal Description:
William R/Mary E 1705 COTTONWOOD DR 26-12-06-401-000.541-028 NORTHBROOK HILLS 44
Thompson PRINCETON IN 47670
Complete and return to: p 1111111111111°;711117111r 17!`111111 q!" tn!371t18(IIIIF,lrinrEnl!
II?�1i1 pinll urt' !.t la IItliL!�9��L'c'IB!:1::31.c.Ea��..t'1
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2 TAXPAYER INFORMATION ' rf
Owner 1 First Middle �}� '
(.0(..-) I1 a m Last
/ Yli/�Yn-�SoJ'1
Madvg Address Intmber and street,Oy,state and ZIP code) I t/ 1°as property address /
-
spouse First - _ Middle. • Last
Malting Address(nun&and sheet,city,state and ZIP code) �( as progeny address
L J
.
Each undersigned certifies,under penalty of perjury,that the above ana foregoing information is true and correct and that he or she is eiigiole to receive me
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
- I Date
,
FILED -----
NOV 7 201
GIBSON COUNTY AUDITOR
aa �'h°, CLAIM FOR HOMESTEAD PROPERTY TAX
;,'�;; CREDIT/STANDARD DEDUCTION
:�:,� • State Porm 5473 (R2 / 5-92)
uo
INSTRUCTIONS: See �everse side fai liling ins[ructions.
FORM
HC70
YEAR
Ne) _����1`, � �� �� certify th t t da ch 79
�a) � d as our principal place ot residence ihe oll wing described reai property for which a Homestead� Pr�rty�x�r i aimed:
/
7 I(We) owned ❑ Are buying under wnirac� . , � ���� Y�,� e
7 4�
� Have a beneficial inierest in the entity that is liable for the property taxes on the property and that owns ihe propert o i uyirtg u 2f 3 contract.
� . � . � CONTRACTRECORDED /�' �AU����`
If buying on comraci. Fee Simple owner's name � ' . . . .
t
Recortler's oNice w�ere comraa is rewrded Record number Page
Counry
V � —1'1
If any portion of
of lhe property �
m
PROPERTY
� Legal descrip't,oq'"� /^' vv �' "�
`V � \
or Ihe land not enceeding one (1 � aue that immediatety surmunds thai
is used to produce income, destribe the use and ponion
� PROPERTY OWNED BY CWMANT IN OTHER COUNTIES
County Township Count
't.
��eby certify the above statements are true, correct and complete. Signam�e oi d imam
bdress (number and streeL dry. s(ate. ZIP mde)
D 00
ASSESSOR USE ONLY . ... TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land nol exceeding 1(one) acre immediatety
surrounding residential improvements. (�)
Otherland � (p) �
Total land (line 7 plus line 2� (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 th�ough line � (7)
Total value (line 3 p65line � �g)
I hereby certify the above is trUe, correct. and Signature ol Assessor Date signetl
complete.
�'4ing accion - Signature of Autlimr Date signed
L
79_Pay19_
Lesser ot 1/2 Homestead
Valuation or 52.000
DEDUCTION ALLOWANCE
S
signetl