Homestead_Andrews 0
STATE FORM 53569(R3/B-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.'AA - FRESCRIa0 nY TEE DFPARTMEVE OF LOCAL GOVERWEST FINANCE IC 61.1-223.1
Gibson County Auditor 1MPORTANT'NOTICE TO-HOA1ESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and marled couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
Princeton, IN 47670 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
FILED benefit and to provide additional identifying information necessary to allow county authorized government to better monitor homestead
0 filings.This. information will be kept confidential and can only be accessed by au ho zed coun officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTI•INFORMATION ' •
MAY 4 2011 Taxpayer Name Location Address
C N Andrews, Barbara L
v rv\ 105NPolk
GIBSON COUNTY AUDITOR Fort Branch IN 47648
2139
Barbara L Andrews II-I[iI1_1IDII I LIII IIII] III11II1LIII.II_IIII III 11111UJUI0IIIIII
105NPolk
Fort Branch IN 47648-1319
liltlhlllltliliilhililll"I'I'IlIIIlI'IIIItiBI6111I11IIitIllli State Parcel Number Legal Description
26-18-13-403-000.017-026 MPG ADD 6 MPG ADD
13-3-11 "05 AC
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2:TAXPAYER INFORMMATION
0 I First Middle - Last
Mailing Address(number and street,cit ,and ZIP code) ��-\ , / prep s address
lOS /1/ 6 //4/ Ff /J/ 4 d Ii/ y .
PART 3: CERTIFICATION • ,
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 Sign '- Date
)
" PART 4: ADDITIONAL INFORMATION •
•
�E [4� .
� g CLAIM FOR HOMESTEAD PROPERTY TAX
a���;; CREDIT/STANDARD DEDUCTION
�,` • State Form 5473 (R2 / 5-92)
..�.
INSTRUCTIONS: See reverse side Ior liling instructions.
�
� �
ai�`' i :i�
i �. „ ��,
� L�.�� 1./�
I iWe) � m , � certif��igq.i�i@,tsi aaqot M c,a�i�'
�;) oy upied as our principal place of residence the follovring described real property for which a Homestead Property Tax Or�i�t�� Ga ed:
� / A
!JlYIWe) owned ❑ Are buying under coniract __
L7 Have a bene(icial interest in the entity that is �iable for ihe property taxes on the property and ihai owns ihe property or is buying under a contraci..
� � . . CONTRACT RECORDED � � � ' . ' - � �
If buyinq on coniract, Fee Simple owner's name . . . � �
Recorder's oHice where contrect is recorded Record number Page
CounTy
Parcel number
Township
legal descnption
PROPERTY DESCRIPTION�
v��—�c�v � ► —cx� i
It any portion ot t�e residentlal SlrucWre or the land not ezceetling one (7)
of Ne pmperty utilizetl ro protluce income.
,
fown,
that structure is usetl ro produce irmme, descnbe Ne use a� ponion
� PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES � �
Counry Township Counry Tawnship
� Signature of cl � ant
eby certify Ihe above statements are irue, correct and complete.
Address (numbe� and sneef, ary, siate, ZIP mde)
. ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL
� VALUE VALUE VALUE VALUE
Land not exceedinq 1(one) acre immediatety ,
surrounding residential impmvements. (�) �
Other land (p) �
Total land (line 7 plus line Z� . (3� ,
Dwelling (4) -
Residential improvements �
Garage (g) .
Other improvemenis (6) "
Total improvements (line 4 through lina � �7)
Total value (line 3 pbs line � (g) .
I hereby Certify the above i5 lrue. Correct, and Signature of Assessor Dare signetl
complete. �
tying action - Signature ot Audiror Date signed
;�
- STANDARD DEDUCTION ALLOWANCE -
19_Pay19_
lesser of 1/2 Homestead
Valuation or 52,000 �
Sign tur � Audilor . Dare signed
� /d� -9
_ - — _ � �� _ -� -._,�., -...- � _ �
�