Homestead_Tenbarge (2) STATE FORM 53569(R315-10) TREASURER FORM TS.IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY TEE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.I 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
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
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.
.PART1c PROPER Y 1NFORMA ION
Taxpayer Name Propeets Address State Parcel Number Legal Description:
Bernard A/Lisa M Tenbarge 506 E PLUM ST 26-23-06-100-000316-009 PT W E 6-4-10 1 AC
HAUBSTADT IN 47639
Complete and return to: 1 1111110F01BDU iR CK11[1]II®Id 1111ElD]O1110IE
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
. PART 2 TAXI AVER INFORMATION „ . -
Owner 1 First -- Middle Last
Mailing Address(number and street.atty,slate and ZIP code) ��
ITAsame as property address" '
506 E. 6'kLAJn S1 N#9 tic t35TliiT 1 ) ti76 39
First Middle Last
L 1311 /77 7-- - e1) 4026k
Maling Address(number and street dry,state and ZIP code) I A Sarre as property address
_ ' '
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 A: AnurrloNAL 1\FORMATION '-
- - - FED _ - --
• NOV 192012
c.�.ritnrs..... -
GIBSON CUUN I Y HUUI I UK
e� g CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
.., • State Form 5473 (R2 / 5-92)
rug
INSTRUCTIONS: See reverse side for filing instructions.
WE=
,{CERTIFICATION STATEMENT �j "['�"
�:) certify that on the 1st day of March, 19, [
I Ile) occupied as our principal place of residence the following described real property for(vilhich a Homestead Property Tax Credit is hereby claimed:
aI (We) owned ❑ Are buying under contract
❑ Have 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
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
PROPERTY DESCRIPTION
County - -
Township
Township
Taxing 'st t (city, town. township
Parcel number
of —0051 to -aC)
Legal description
Pt
.
( -4 0 _ l a c
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
Land not exceeding t (one) acre immediately
surrounding residential improvements.
(1)
-
_reby certify the above statements are true, correct and complete.
fi n .u) of claimant
.. r s (number and street, city, state, ZIP code)
�.L 41-1c
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL.
VALUE
Land not exceeding t (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pfrs line 7)
(g)
I hereby certify the above is true, correct, and
mplete.
Signature of Assessor
Date signed
ying action - Signature of Auditor
Date signed