Homestead_MastCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
Stets Forth 5473 (R614M)
Prescribed by the Department of Locel Doverrunent Fewnoe
INSTRUCTIONS: See r vwn side for M'rC itabuctions.
MAR 0 12006
I (We) 7/ / Ale &L sir' ,6dZtlA/d >l/ V/b -d � certify that o the 11 a ch. 20
I (We) occupied principal place of residence the following described real property for which a Homestead RBNP�4&QAW1Ys fit gffWimed:
❑ I (We) owned ❑ Are buying under contract
aHave 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 on contract. Fee Simple owner's name
Recordees office where contract is recorded Record number Page
ROP.ERTYOYJNED'BY'CL''AIMANT
PR0PERTY< 6ESCRI0.TION�r '.�- 'r'"�._i's2.�',' -�.
Count'
Tcwnship
County Tavnship
T g I (city, t , town ip)
U N
hereby certify the above statements are We, correct and complete.
Si r a' anf
Parcel number
Legal d "ption
Is the property in question:
❑ Real property ❑ Mobile Homo (LC. 6-1.1 -7)
If any portion of the residential structure or the land not exceeding on
(1) sae that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
ROP.ERTYOYJNED'BY'CL''AIMANT
IIJOTHER'COUNTIES
County
Township
County Tavnship
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1).�
hereby certify the above statements are We, correct and complete.
Si r a' anf
dress (number arxf s I, °�'/�'efe, ZIP e)
d2 �WP bSicl�
(2)
3`...
SSOR, �3 - �
3'ASSESSOR�USE ONLY:i61WRA
.TRUE-TAW r -i
LUE yX
ASSESSED VALUE.
' ATy100 %'OF T:TV
HOMESTEAD
.�` VALUE .<.
.00
`t' NON�aiESIDENTIAL
� 'ey_VALUE
:v,'>. � ,..
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1).�
... -r. r..��
t•,„q.- '
Other land
(2)
- `"«j�{
FX§yw 3f Y'-.'i
Total land (line 1 plus line 2)
(3)
Residential Improvements or Annually
Assessed Mobile I Manufactured Hone
Dwelling
Garage
(4)
(5)
:i °X xi
Q , $' Y - M
all
Other improvements
(6)$
x'' i M r.- :-:-r
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is We, correct, and
complete.
Signature of Assessor
Date signed
Vedfyng action - Signature of Auditor
Date signed
;Sr- STANDARD: DEDUCTION` AL LOWAMCE,Sxr3,'_ ",stk
20 _ Pay 20
Lesser of 1/2 Homestead S
vauabon or 535.000
Signature of Auditor Date signed
STATE FORM 53569(RJ/2-M) TREASURER FORM TS-IA
APPROVED BY ST:FE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE(Co-1.1-22-s.I
• ' • IMPORTANT NOTICE TO ROMESTEAD;PROPERTY.'OWNERS
_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.
fuses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers-who receive the homestead --.
. sr.,edard 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.
PARTI: PROPERTY INFORMATION "
Tasnaver Name . Property Address State Parcel Number Leval Description:
Matthew R Mast I I S N VINE ST 26-I9-31-301-000.361-009 ORIGINAL PLAN 107/108
I-IAUBSTADT IN 47639 )
Complete and return to: 11111 11[I Ell BM 11CIIDll®Q��I®IfllLLa LYOl®m®®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 ll OHO! �IWWIW LY
PART 2: TAXPAYER INFORMATION - -
Owner 1 M '1- First / Middle,
tit-41 n �1FuI/ .. _/U :. cl (a: . _ _ - M` CIS/-
Magog Address(number and street,city,state and ZIP code)
Xi Sarre as property address
. First
Middle Last
CG 6 fe01 I y k1 n • As 5÷--
Mailing Address(nurrter and street-city.state and ZIP cede) \I <
Same as property address
. . 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 1 Signature Date
PART 4: ADDITIONAL INFORMATION '
FILED .
• DEC 272012 - .. • -
c .
GIBSON COUNTY TOR