Homestead_M & S Properties and Contractors LLC (2)CLAIM FOR HOMESTEAD PROPERTY TAX PG FORM
CREDIT/STANDARD DEDUCTION
State Fenn 5173 (R71
Rvsaibed by the Depar nent of Loral Government Finance
INSTRUC77ONS: See reverse side for miry instructions.
10 11 CERTIFICATION STATEMENT
1 (We) certify that on the 1 af,
1 (We) occupied as o princip pr ce of residence the following described real property for which a Homestead Property Tax Credil',�e p
,I (We) owned /l e p_[�,�( h buying under contract �IBSON COUNTI Y&
J Have a beneficial interest in the entity that is liable for the property taxes on under the property and that ovens the property or is buying uer a contract
CONTRACT RECORDED.'.
If buying on Sirtrple carters rema `
Rarxrdees office mrrtiad is recorded Record number `• page 0
PROPERTY DESCRIPTION
County
Township
Tadrg district (city, torn. township)
Township
Legal description
Is We pi0plie in quesnn:
net property Mobile Home (Lc. 61.1 -7)
If arty portion of the residential strumxa or the land not exceeding ono (1) acre Mat immediately s mmids Wert is used b produce income. describe We use and portion
of We pgpttM produce 'rrmrtre.
&cc -Gco �dk 4vc
- - PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Tarnahip
County
Township
I hereby certify the above statements are true. correct and complete.
Signalu d
PAfSea (number end street, city state, ZIP Dada) o rd j N
ASSESSOR USE ONLY
.. ..
TRUE TAX.
VALUE
ASSESSED VALUE
AT160% OFTTV
HOMESTEAD
VALUE.
NON4tMDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
�1)
..
Other land
(2)
Tdal land (lire 1 pkis tine 2)
(3)
Residential improvements or Annually
Assessed Mobile I Miaufarbued Home
Dwelling
(4)
Garage
(5)
._ .
Other improvements
(6)
Trial improvements (Ikre 4 through fine 6)
(7)
Tdal value (fare 3 pks tine 7)
(6)
t
I hereby certify the above is true, cared. and
complete.
Sgneboa d/sessar l
Data signed
Veilyirg action - Signature of ALxfdw
Data signed
STANDARD DEDUCTION ALLOWANCE, - -
20 _ Pay 20 _
Lesser of 12 Homestead
Valuation or S36.= S
Signahae dkaffe"
Date signed
STATE FORM 53569(8318-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-8.1
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
',causes 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.
PARI PROPERTY INFORMATION
, i.,. _ , .....
Taxpayer Name Properly Address State Parcel Number Leeal Description:
M&S Properties and 306E VINE ST 26-04-25-300-000.434-020 WOODS ENLG 2122
Contractors LLC PATOKA IN 47666
Complete and return to: MQElII11.IIflU]Df00m R D]IHDJ UU0[1]D11,®M
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
''''F'".- -1.'"C'..4111.' J t t S L . I L L I PART':..TAXPAYER INFORMATION I'(e fR yh ":-.c t I IF I` ! 4.; .t:jr:
Owner I C Y First Middle Last
Mail Address(number street, s ward ZIP code A LI—,E A} 8 O ,�
ty, ) I I Same as property address
do 04-
4'% j, — o•
y
Mailing Address(number and street,,dry,state and ZIP code) Same as property a Qt r-r ,P
Q. c'C 4
U G?J
Social Security Number(last 5 digits) Driver's License/State ID Number(last 5 digits) Sate Other(please specify in Parw'below)
Co P
I,., PART3: CERTIFICATION _. •,,1,;
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
Spouse Signature Date Telephone
( )
PART 4: ADDITIONAL INFORMATION ., —.__ •--..
•
I qt S. V it l .• ■•