Homestead_Teetersa tnROQ CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions.
^QERTIF10ATION STATEME,N1 It ) _,O` '
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1 (We) certify that n'the 1st day of March , 19 I�
�We) occupied as our principal place of residence the following described real property forwhich a Homestead
roperty Tax Credit is hereby claimed: \..�(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.it under a contract: 4 , •
CONTRACT RECORDED
If buying on contract. Fee Simple Owner's Name
Recorder's office where contract is recorded .. Record Number Page
ur.JL.n
Parcel Number Legal iption- :
YY1D iif -h - �f -��c
If any portion of.the residential structure or the land not exceeding one (1) acre that•immediately t ��u�
ture is used.to produce income describe the use and portion of the property utilized to produce im I] �}
-6ja-.70-U /,7--
JUN 2
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
`� 1990'
County
06 _
Township
County
T wnshi
_ nereby certify the above statements are true. correct and -
complete. - -
Signatur !'
r- C.
Address (Street. number, city. state and ZIP code) J
t Rid Y3o
(0 0 o
ASSESSOR USE ONLY TRUE TAX VALUE ' ASSESSED VALUE HOMESTEAD VALUE NON- RESIDENTIAL
1rMR 170° R a - - VALUE
Land not exceeding 1 (orie) acre immediately
surrounding residential improvements
Other land
Total land - line (1) plus line (2)
_ Residential improvements Dwelling_
Garage
Other improvements
Total improvements - line (4) through line (6)
Total value - line (3) plus line (7)
(1)
1991 Pay 1992
Lesser of 1/2 Homestead
Valuation or $1,500
19 —Pay 19—
Lesser of 112 Homestead
Valuation or $1,500
-
(2)
Signature of Audito
(3)
Date Signed
(4)
(5)
(6)
(7)
(8)
1 hereby certify the above is true.
correct, and complete
Signature of Assesor
Date Signed
Verifying Action - Signature of Auditor
Date Signed
STANDARD DEDUCTION ALLOWANCE
1989 Pay 1990
Lesser of 1/2 Homestead
Valuation or $2,500
1990 Pay 1991
Lesser of 112 Homestead
Valuation or $2,000
1991 Pay 1992
Lesser of 1/2 Homestead
Valuation or $1,500
19 —Pay 19—
Lesser of 112 Homestead
Valuation or $1,500
Signature of Audito
EJ .
Date Signed
i
li
STATE TARN 5350(R V&10) TREASURER FORM TS-IA
APPRL/.ED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC61.1-22-B.I
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
eauses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
Sta Idard 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.
PAR Ti PROPERTY INFO'MATION
Taxpayer Name Property Address Stale Parcel Number Legal Description:
Steven E Teeters 8001 N 75 E 26-02-58-014-000.882-0I8 PT MD 14 1-10 4 AC
HAZLETON EN 47640
•
Complete and return to: IllllllDn7 IV DDllf' MIIIIIIf71� IfEIf11]fallm®
• GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IIINJ 47670 - n Ltd LL LLll llt Y
PART 2:TAXPAYER/ICI? FORMATION ��
Omer I S First �_�,A,A/\� • Meddle 7—i- /eR� last
rV
Mailing Address(number and street.city,state and ZIP code)
�1/� /'
8O0/ N7SE fAZt-E7° TA/4 7'Cy° ��asp opeM addres
Middle last
�i:5�i'nr� VV�r�v1/v�!A1� a�ef � _ ee�eYS
Mailing Address(number and skeet,oty.state and ZIP code) V I I Same as property address
e / At 1g E (2-zleai .A/ `{ 7(/'el°
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
PART 4: ADDITIONAL INFORMATION
.
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Nnv132012
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GIBSON COUNTY AUDITOR