Homestead_Bacchi STATE FORM X3569(R3/8-10) TREASURER FORM TS-IA
APIROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.I-22-6.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS-& f('
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
uses 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 Loc.
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
_ -: PARTITPROPERTY !NFORMATION • ;: c . ( ti- _=
Tatpaver Name Property Address State Pa reel Number (,Seal Description:
Chris Bacchi 206 S LINCOLN ST 26-19-18-303-000.039-026 WALTERS ADD 116
FT BRANCH 47648
Complete and return to: I IIG[Ii11t0�1��11[IIRI��II'll ll�l l!1�1On 130;10711q�
a ar aeuu uriutt WU tl U4 *I¢addll:Iridtau
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
' ' • PART 2:.TAXPAYER INFORMATION '_✓ _ .' ; '"tr".+3.`w ;> p'
Danner 1 First Middle Last
e hr' lS A6 ° rn 13 acck�
Mailing Address becaod saeeLcity.state and ZIP code) Same as property address
Boxlaa c'-� - t-t F Llw`f$"� •
J se First Middle Last
Mailing Address(number and areal,city,state and ZIP Hide) Same as property address
Social Socially Number(last 5 digits) Driver's License/State ID Number(last 5 digits) State Other(please specify in Part 4 below)
.�. r •i:;..�PART 3: CERTIFICATION3:sea, ' '. yi 'I_
'1�; . :'fir.:
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.
O 1 Signe e Daze
FILED
•
DEC 21 2012
• CJ.
GIBSON COUNTY AUDITOR
CLAIAA FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Slata Fam 5�73 (R6 / M3)
P�esMDed by Ne DePSrhneirt d Loral Govamrtbnt Finaixe
INS7RUCT10NS: See raYS�rs aida kv �rp 6mbuc6iy�¢
FORM
I � YEAR
HC10
��e� �T� ������! ��/ certi�}u�at on the��l3y o( March. 20_
I(We) occupied as our principal place oi residence the following described real property for which a Homestead Property 7�c Credit is hereby daimed:
❑ 1(We) owned ❑!ve buying under contracl .
� Have a benefidal interest in ihe enfiry that is liable (or the property taxes on ihe property and ihat,o_wns lhe�o.perty o__ rY,is buying under a wnVaG.
If buying on conirad, Fce Simple owners narne
If any
o11he
ofice where conirad is recorded
Tamship
Legal
Ta�ing disiricl (r�ry, mwn,
Ihe pmperty
Record number � Page
�„� � �.y � V � �y�t_w�_� �� �F2pal praperty ❑ Mobile Homo (I.C. 61.f-7)
� v
+dentlal sWCWre w tt�e lantl not exceeding one (1) aae Ihat immediatey wrrounds that swdure Is used to praduce incane, describe Ne use antl portion
1a Moduce ir�coma.
20_Pay20_
lesser of 1�2 Homestead
vauahon or 535.000
3
Datesg� /J^// D T
i J