Homestead_DewusCLAIM FOR HOMESTEAD PROPERTY TAX G TEAR CREDIT/STANDARD DEDUCTION �C
Sate Form 5673 (R715,4M ^•,
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P�espbed by ere DePatnnad of Loral Government Finance
INSTRUCTIONS: See reverse side for Aing instructions. n r- r - _ _ - _ _
I (We) �/ 6.C.t- L- /CICI.CJ Q certify that dgq nmh, 20
I (We) oaapied as our principal place of . esidence a following described mil prope:,y for which a Hmrestead�S5t)( ft sA)Uffihv %aimed:
V7t. We) owned ❑ Are buying under contract IOR
Have a beneficial interest on 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
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It to yt g on centacL Fee Simple owners rmrne -..
Iemrders office where cordmcf is raarded Record number Page
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PRbPERTV oESCwwnoH -
Camty
TowNdp
County
Tasbg ' ' (CRY town township)
Parcel munber �( esrn�pbap \�
- a U �O �J
- I bl the m q
-� ❑ Mobile Fbme (LC. 61.1 -n
if any portion of the residential strurAxe or the lad not exceeding ono (1)
that inmed�ely surrounds that m used to produce nmme. desoibe Me use and portion
d rty uhf¢ed to wodt. i ..
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a1410-4a o9 -az�a -0/ �7
fi {.''•.i•'.'' PROPERTY. OWNED . BY CLAVAANT 91'OTHER COUNIIES.
County
Township
County
Township
1 hereby certify the above staternens are true, cared and complete.
VALUE?
'dress (number and street oty, state• ZIP code)
• - .•; ASSESSOR USE ONLY - •'
. r TRUE.TAX t.
"
ASSESSED. VALUE
HOIIESTEAD,
ti NOMMSIDENMAL -``
VALUE?
-AT 100%,Ofjy
',VALUE °'
VALUE -'
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Land not exceeding 1 (one) ace it rnedatey
surrounding residential improvements.
1
O her land
(2)
Trtal land (fine 1 plus lee 2)
(3)
Dwelli �
(4)
m
Residential'vnprvveents crAnrwally
Assessed Mobile I Manufactured Horne
Gait
(5)
I
'• ''t .,'V' #'V^
.J
Other improvements
I(6)
Tdal bnprovements (fine 4 tivorrgh Aire 6)
Thal value (lure 3 plus firm 7)
I hereby car* the above is true, correct. and Signature atl� =sessar
Date signed
fI
c replete. ---------- - -1- -- -
—�
Verifying action - Swmhae of Auditor
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.. �,; .: �. _ :.STfWDARDD�tiCT10N�e`- LLOWaMCE -
20 _ Pay 20
Lesser of 12 Homestand
Valuation or 535.000 ' S
Date signed
STATE FORM 33569(R3'A-I0) - TREASURER FORM TS-IA
APPROVED BY S FATE BOARD OF ACCOUNTS.20‘ _. PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1-22-Et
- - - 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
muses 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.
PA'Tl: PROP R Y :`FORMATION ,
Taxpayer Name Property Address State Parcel Number Legal Description:
Matthew A Dewus SR 65 26-02-09-000-003.258-017 PT SURVEY 9 1-10 1.072 AC
PATOKA IN 47666 C-I D-12
Complete and return to: IIIIIIIfIn11n01JIID i i Ill i�®nplflllll[Thtl Ifll��mlllll
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 !ll llll¢1 LLI LL0 !J
PART 2: TAXPAYER-INFORMATION
Owner 1 First Middle last
M A Fthe k J l-I/�nri-O/7 ! J-2 W L1
Mailing Address(number and street,city,state and ZIP code) Same as property address
o / N SR Co5 -V
y yA40 La_ =ft/ 4-/7cPieC,0
) :
Spouse First Middle . Last
•
-ePAan ie -F,4;/ T Jel..0 Gt."S
Mailing Address(number and street,city.slate and ZIP code) Same as property address
yCIO / N. s 06 PRfokn —^d 41 CQCQ Cv
: ,:PART 3i 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 -
, F IL 7-- r-ve;\
. NOV S 2G';%
GIBBON CUUNfI „it:, ?