Homestead_Arms STATE FORM 53569(R1S-09) TREASURER FORM TS-IAI '-
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.I-22-S.I
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
4 duction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
auses higher tax bills for all; therefore, HEA 1344-2099 requires taxpayers who receive the homestead
st ndard 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 I: PROPERTY ,'FORMA ION ,. ,
Taxpayer Name Property Address State Parcel Number Leal Description:
Amanda Arms R 30B-iv— 7 g`�7 S •la 96-63. 26-421-00880-00 PTE&PT W 2 4 11 87.891 AC 0.2
we
O V
LJP.IISV/lh°r ��
Complete and return to: r'rt `r
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART?: TAXPAYER INFORMATION
Owner I First Middle Last
,9M2nda -Art e. - . Anns
Maang Address(number and street,ay,state and ZIP code) 1�
I Same as property address
SPwse First Middle Last
Mating Address(number and street.ay.state and ZIP code) Same as property address
Social Secunty Hunter(last 5 digits) Dives License State ID Nwrder(last 5 digits) Sum 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 1 Signature Date
PART 4:ADDITIONAL INFORMATION
ill •
rf"` CLAIM FOR HOMESTEAD PROPERTY TAX FORM Y A YEAR
/1 + CREDIT/STANDARD DEDUCTION HC1O M JJ
Sfate Form 5173 (R7/5
./ Prescribed by the Department of local Government Finance
l ' INSTRUCTIONS:See reverse side for filing instructions.
- C , r ;-f g xt o`'. 5±. ; r t - .A+ t t kv;;r - y - l X .t L , c .�l
Pa;x-�. .�...�kl�./'�./)'�u��p�'/iQ�.''.Le•�.(/./���'s-.,tw.•�r k,-:�.�./,.y.,�.t..C�ERTIFICATiON STATEMENT< .��..r ..?��„w« s....v-. �. ,v}*..�•' •i•?S°`+i��r si°�.S
I(We) CV r' j ■a".wiJ - �.�""A "'. a- ��bpppyyai�mmmmoggggg...tltddht�teeeee 1 r , arch, 20_•
I(We)occupied as our principal place of residence the following described real p-operty fcr which a H Tax 1 is a-i daimed:
I iii
(We)owned ❑ Are buying under contract 11 /
ave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pont oxis9 yinp under a contrac.
y..- r a' �oi;
:•,r.'.:. �x�'�I+. rd' `7n'>t�e -hr�':S3',.wYt�.�bi16'v'3c�6.}�r!k�,3�y�F:CONTRACTARECORDmcd':�i55 3:a:,r .dif.6r�"ta�F�x'' iu,; ~
If buying on contract,Fee Simple owner's name Or
GIBSON COUNTY AUDITOR
Recorders office where contract is receded Record number Page
a_ :MN {'.i'' "'rent+ Yu t v, {PROPERTY - --" 3, r n as-=n c t M-• - gr rn 3u ens-v
...ac's, i'tiEri1�4:�: - f -x.. . ._ i .. .. .»-. t. ^ ^ .r :'7 ,7 °r�2tk;E�?�:�k
County Township Tang(F-,•. =r. • .township)
/a .4 51
Legal descdp r Is the property in question:
g�_ � � ..., .. _ t � ❑Reel properly ❑ Mobile •. 1. Lf-7)
Wef �idential strudue or t e •nerrNri c• ••- 'acre that immediately surrounds the structure is uss�eddd to produce u ,describe and portion
of the rly utilized to produce income. / ` e /_ /T j Patio
7 dz.. du_401--o/7- el
II
Y 9:1 x. Sa _t✓S ."a;'i'P R O_PER ?_ ...
OWNED..BY,CL'AIMANTtOi_OIHER COUNTIES at'?ki�.:E?3up kv,v-r„r”: .,.Y h.�'.4,;:'t�K_•+=
���//^��\\�County Town hip County Township
retry certify the above statements are true,correct and complete. Si.. :of claimed
1Lfle//. • • . i . ' / //AC
• .•er sandshoe.city,state,ZIP code)
f ,x.1/1 Z,'Y n T" 5]llplG, n i f V - /' ict t _ )'�... - _ }S,W;„,
;11 _„,�,,`t'x°(1( ASSF,aOR,USE SONLY''c,It tt,t e''$fJ �'7;yALUE Y' }i, JA.SSEOSSED F T11UV4 °3 V W. D.^)!x at.".W2 7!-VA-)UE A kt' r="f}.
't,:.•,ss?�i.+ sty, h'ra:==" -
Land not exceeding 1 (one)acre immediately s-mot ran �+- ,ty.,l, 1
surrounding residential improvements. (1) #y��: 'c'.°,,� t`r7',s'
Other land { 'r"f�` cu
092 2 _wage
Total land(Tire 1 plus fie 2) (3)t "rw-mil`/" C g /03
-w T� tM W t it
Oweting (4) . 4ftr �era"su3
Residential improvements or Annually
Assessed Mobile/Manufarbaed Home -:/ rlaSs' 'e2we•-.-� 4�.".,''xi.,
Garage (5) aaja- •% aSO/et 00 Or.,�,L25i a ,Va TYz : ,r:
Other improvements (6) K;fie 4
Trial improvements(fire 4 through fine 6) (7)
Total value (fine 3 pis fine 7) (8)
- I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auddw Date signed
9 :ms' �, Weilt'�."„ ��c,.a,;isWVsTANDnIen'DEDUCTION'nIILIownncEr `fsrgrat5tr''. i?��itirarrs"� alrecka
20 Pay 20_ 11•,
\\ Lesser of 12 Homestead \r.J
\{ Valuaatio)n�orr$$35.000 \ \ S
Signature of Auditor li r1/ V + Dare ednI