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Homestead_BrownYEAR CLAIM FOR HOMESTEAD PROPERTY TAX FORM { CREDIT/STANDARD DEDUCTION coo State Form 5473 (R5 / 10-01) Prescribed by the Department of Local Government Finance INSTRUCTIONS: See reverse side for filing instructions. ED ON STATEMENT'• 7 U 41 �::( fUU4 I (We) J /Xj dlxcl�& a n the I t ada of Ml�lch, 20 7� car'!' 'h I (We) occupied as rincipal place of residence the following described real property for m �fat r )P4" which a Homestead t- V IBS01141 COUNI Y AUDITOR EEJ1 If (We) owned ❑ Are buying under contract )48 dhHave 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. C 0 NTRACT' RECO RD E D r If buying on contract. Fee Simple owner's name Recordees office where contract is recorded Record number Page 7 .'PROP ERTYMESCRIATION County Township I hereby certify the above statements are true, correct and complete. n di trict Y. to 6unumber and street, city, state, ZIP code) m 136) x AR .0, 4�WFA7& 4,1 24� OFTTV� L E rt, I & 6 Parcel n be �16i5-?6:7a 6 Legal description Is the property - uesdon: I 0/97, -54 Real � property ❑ Mobile Home (I.C. 6-1-1-7) 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. 7 County Township county Township I hereby certify the above statements are true, correct and complete. Signattjebf claimant 6unumber and street, city, state, ZIP code) m 136) x AR .0, 4�WFA7& 4,1 24� 34 1 RE. !�:;k.TRUE-TAX,:: -L!,�!SESSMILJSE ONLY- ASSESSED,VALUE 'AT,100% HOME ST fili t,�, NON -RESIDENTIAL.-'11 -', VALUE-,"'-!,',-, OFTTV� L E -VALUE4 Land not exceeding I (one) acre immediately -54 surrounding residential Improvements- Other land (2) 4 Total land (fine I plus line 2) (3) Dwelling (4) t Residential improvements Es' Garage (5) g w Other improvements (6) Total improvements (fine 4 through line 6) (7) Total value (line 3 plus line 7) (8) I hereby certify the above is true, correct. and Signature of Assessor Date signed complete. Verifying action - Signature of Auditor Date signed TANDARb:DEDUCTION,ALLOWANCE .—,-zd'?'-.;.�k,,,,.��,'�Y 20 — Pay 20 Lesser of 112 Homestead Signature of Auditor Valuation or $6,000 $ Date signed STATE FORM 53569(113/5-10) TREASURER FORM TS-IA APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT.OF LOCAL GOVERNMENT FINANCE ICS-Li-22-8.i IMPORTANT NOTICETTO 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 •auses 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. - .PARTI: PROPERTY IN O'MA ION -, Taxpayer Name Property Address State Parcel Number Leal Description: 110 W BLUE JAY ST Gary R Brown 26-04-25-300-000.595-020 HUDSON FARM WEST B PATOKA IN 47666 v In Complete and return to: I®IIQ1M113 N]QQm©�D]IN mf EI tIIIMIDW GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 la -PART 2: TAXPAYER INFORMATION Omer I First Middle Last 62-19-As IC , ,6''t u t� Mailing Address(number and city.state and ZIP code) I j Same as property address 110W. 61UP T/9/ 671 ,0 97tt'n Z"P,0 31 6 . Fuse Middle Last /1400 4 ,C r fIrv/,eJ,v Mailing Address(number and street,city.state and ZIP code) Same as property address 1/4,94-002e Other(please specify in Part 4 below) 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 I Signature Date e Ii ' I . I` p . pp H (1 H ii -II kin" i 91119 • V GIBSON COUNTY AUDITOR `\`�`- l7