Homestead_Bender (3) •
MATE FORM',flair/ fPI-ssUrER FORM 711A
APPF'En BY MATE an\RD(F MYYRR%mt_`o. PRInJB1 BY DEPARnYencf LM'ALrsn^etMMrwriaa4'EMLI.1-r_?I
Gibson County Author
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 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 In bills for all:therefore.
HEA 1344-21109 requires taxpayers who receive the homestead standard deduction to verity that they are eligible to reecho the
benefit and to provide additional identifvin_ inform:mon necessary to allow county government to better monitor homestead
tiling:+.this information will he LEp cnnlidential and can only he accessed by aulhnrned county officials.The Depanment of
Local Government Finance will use this information to cream wok that will help county officials eliminate homestead baud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Bender, Robert Michael
12 Red Hank RD
Fort Branch IN 47648
6985
Robert Michael Bender
12 Red Bank Rd State Parcel Number Legal Description
Fort Branch IN 47648-1546
II III nI n II nI on II I I I III II I I III 26-18-24-201-000.061-026 011-00061-00 LAGRANGE ENLG 216PT
n
I riff I f I ti it t n t n r
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Po D a0A-- 1111011 Esc, �r-
nu Address(number and street,city,state,and ZIP code)- - -— ------ -- L�G -6'eme is property oddr s - -
/f>Z Pk- 1 (3 c 4or 21 W-vim . 4'76-y
Spouse First Middle Last
V' atev 0 en>
Mailing Address(Number and street,city,stale.and ZIP code) g Same as property address
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 Si a Date
PART 4:ADDITIONAL INFORMATION
..,�,,, .
ea g CLAIM FOR HOMESTEAD PROPERTY TAX
i' �
CREDIT/STANDARD DEDUCTION
� State Form 5473 (R2 / 5-92) �
��%'
�aie
INSTRUCTIONS: See reverse side for liling instrucfions.
7T !�7
•�y � � �a'�
e
MAY � 0 1996
i^ve) \ X6�,,,�` jY �_��A/l� . certify thai on ihe 15�e�Q�7arLp� 19�
�.) occc(�iied as our principabplace of residence the following describedreal property tor which a Homestead Property Tax Credit is hereby claimed:
r I(We) owned ❑. Are,buying under contraci , . �
❑ Have a beneficial inierest in ihe entity ihai is liable for the property taxes on ihe property and that owns the property or is buying under a contract.
� CONTRACT�RECORDED �
It brying on coniract, Pee Simple owner's name � , . � _ '
flecortler's oHice where contrect is recorded Record number Paqe
Counry
Parcel number Legal de:
�I�-Ooo(�� C
tl any portion of the residential structure or the land not
o( ihe pmpeny utilized to produce income.
PROPERTY DESCRIPTION
� � Taxing di;tril in
✓� \
one �H aue
fownship)
ihat structure is used ro produce income, describe the use aM portion
ASSESSOR USE ONLY - TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land nol exceeding 1(one) acre immediately
surrounding residential improvements. (�)
Otherland (z)
�
Total land Qine 7 plus line 2� (3)
Dwelling (4) �
Residential improvemenis
Garage (5�
Oiher improvements (6)
Total improvements (line 4 through line � (7) I
Total value (line 3 pUs line � (g)
1 hereby CeRify the above i5 irue. CorreCt, and Signa:ure of Asseswr Date signed
complete.
.. -�rying aciion - Synature of Auditor Dare signed
1
-L
� � STANDARD DEDUCTION ALIOWANCE
79_Pay19_
Lesser of 7/2 Homestead
Valuation or 52.000 S
SignaWre of Auditor Date =i ed,^
. ��N'
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