Homestead_Haireaka 4= CLAIM FOR HOMESTEAD PROPERTY TAX 3 FORM YEAR
y ' CREDIT /STANDARD DEDUCTION z -z Hc10
State Form 5473 (R2/1 -90)
INSTRUCTIONS: Se se side for filing instructions. FILED
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ERTIFICATION STATE
I (We) -
I (We) obhpied as ot9principal placetg
Property Tax Credit is hereby claimed:
d�A� f t r
q c�919
that on the 1 st
residence the fol ing described real proft for w�cl1� Homestead
""�, @fs
I (We) owned ❑ Are �Ii�D�OR r contract
El property a beneficial interest in the entity that is liable for the property taxes on the property and that owns the
property or is buying it under a contract.
CONTRACT RECORDED
If buying on contract. Fee Simple Owner's Name
Recorder's office where contract is recorded Record Number: Page
PROPERTY DESCRIPTION
County .. Township Taxing District y, town town hi
Parcel Number Legal Pascription
- ooS3 IL 0 0 36-3-11 Sr
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that struc-
ture is used to produce income describe the use and portion of the property utilized to produce income-
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
W -ounty I Township I County Township
I hereby certify the above statements are true, correct and I /�Yrf9R3fu e
complete. �{
Addr ss (Street number, city, state and ZIP de 0
ASSESSOR USE ONLY - .TRUETAXVALUE ASSESSED VALUE HOMESTEAD VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (orie) acre immediately
surrounding residential improvements
Otherland
Total land - line (1) plus line (2)
Residential improvements Dwelling
Garage
Other improvements
Total improvements - line (4) through line (6)
Total value - line (3) plus line (7)
(1)
1991 Pay 1992
Lesser of 112 Homestead
Valuation or $1,500
19— Pay 19—
Lesser of 1/2 Homestead
Valuation or $1,500
(2)
Signature of Auditor
(3)
(4) -
-
-
(5)
(6)
(7)
(8)
I hereby certify the above is true,
correct, and complete
Signature of Assesor
Date Signed
Verifying Action - Signature of Auditor
Date Signed
STANDARD DEDUCTION ALLOWANCE
1989 Pay 1990
Lesser of 112 Homestead
Valuation or $2,500
1990 Pay 1991
Lesser of 1/2 Homestead
Valuation or $2,000
1991 Pay 1992
Lesser of 112 Homestead
Valuation or $1,500
19— Pay 19—
Lesser of 1/2 Homestead
Valuation or $1,500
Signature of Auditor
Date Signed
STATE FORM 53569(RLS-IO) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-12-6.1
IMPORTANT NOTICE TO HOMESTEAD"P_ROPERTY•O\VNERS
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
'auses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
Bard 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.
_t. ' t11r t.. N it'C _-NCI
Taxpayer Name Property Address State Parcel Number Leaal Description:
Randy A Haire 519\V SR 68 26-18-36-404-000.534-009 PT SE 36 3 I I .51 AC
HAUBSTADT IN 47639
Complete and return to: - I®IIDD]EHD it DDIERIBI [IfllDQh®IN mU
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 IW
- . PART 2:TAXPAYER INFORMATION ----
Owner 1 First Middle Last
•
�Aadef Alley iliiQe
Malang Address(number and str L OD. Late and ZIP code) J ' �J Same as property address
SO W/ 5E, (0 �� �; _� L1149 9 -
.J --mot 'ter 2— y PO\. 0- t V C_.
Mating Address(ranter and street.city.state and ZIP code) I Same as properly address
1/43'iq w 5R c 8 thLa 1JnS - Qde —L,0t17639
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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 substa tial financial penalties.
Owner 1 Signature e,. Date
- PART 4: ADDITIONAL INFORMATION - ..
-
111- ..P.:,..._.
NOV 1 4 2012 •
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GIBSON COUNTY AUDITOR