Homestead_Pinkstaff CLAIM FOR H i-1-1F DJAplY TAX CREDIT FOR YEAR 1 1c .
SEE BACK F[}R Fic LNG INSTRUCTIONS . •
^ n _ (? . h ,,.. certify that on the 1st day c
T, ich, (A (We) O- 1J�Din-ipal `
14a..4--oh, 19�, I, (We) occupied as our Annr�_nal place of resiuen the following described rAat •
arty for -hick a IImst°ari Property Tax Credit is hereby being claim-19th-
.
ii
are buying under mntLact .
D have a beneficial interest in the taxnayer
County Townshi
Property DA.s..^riotion_ in t 99 _ h
Taxing District (City, Ta:-n, Township) : - jA fl `
Panel rhrber I I I I • I or legal description sinwn on tax statement:
j fl vp.-F,X4 ' ► L1 30 -1 - 9 Ser
If buying J64 hers r (fee simle owner)
• recorded in Pooprder's Office - Record fb. Page
MAR l lye
If any portion of the residential structure or the land, not esxe •l;ng one (1) acre that
is used to incare, des¢ibe the use and portion of
ir�ia� .. .antis -t structcse produce
the prop°-r bai =; -16-..... prod r. incorre .
Pny otter cocrrtis in which individual cans or is buying
real property: County ' Tv msldo
I heathy certify the above sta(tescent is true, correct and couplete. •
Ci X a� �w ¢� I tom✓LanatlSe cli Street Aress City, State and Zip Cods
= ,men a contract that provides he is to pay the
*Irxiividual either owns or is buying
property taxes on the resilience, or has a beneficial interest in the taxpayer.
. - FOR ASSESSORS USE ONLY -
TnL Cash. . Assssai Ilaresteac
Value Valuation . Valuatioi
;n 1 (one) acre u ately ' (1) • " 70
Land not exceOn 9
surrounding residential inprovarents (2) ' ° ��/���/�////�/
Other Land Z/�(o/�o ��������
Total land �k (3) __--- �/ ///////���� ��������/�
Residential LiproVen�tts Dwelling inn (4) // //� �/
Garage (5)
Total (6)
•
Other Imnmvan'nts
I to ov is - Line (6) plus (7) equals (8) (8) SSA o /� ��,
T hs&ry certify the above is true, correct, and mrplete.
viL
Date .
ature of Assessor .
- ACTION BY AUDITOR
Date: 3 - 11 ' &
STATE FORM 53569(R H-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-l.1-22-8.1
: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
buses 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.
: r - : ['ROPE'TY :`FO••MATION - -- -
. . _ . PAR h , -
Taxpayer Name Property Address State Parcel Number Leeal Description:
JeFrety) Pinkstaff 6609 E 350 N 26-06-30-200-000.972-017 PT NE 30-1-9 5 AC C-I
FRANCISCO IN 47649
FFeY-y
Complete and return to: IlII M 91 DU Dll UhlhIIII�11ERRE lIES
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 IW
PART 2c TAXPAYER INFOIL\IATION:
Owner I First Middle Last
JCFrrleY yr1i /n ksirt0
Maimg Address(number and street,city,state and ZIP code) �
IXI Same as property address
- -- -
, First w . Middle Last
PCt.0-,fit SCle_ —t r sr1 K.SirtCrc-
MatTing Address(number and street.city.state and ZIP code) 1•Z[ I Same as popery 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.
Purer I Signature L Date
e ` . PART 4:ADDITIONAL INFORMATION
-ill. • . . FIL, ' 3
NOV 1 3 2012
GIBSON COUNTY AUDITOR