Homestead_Burger _ a
• alATE FOR.'1,,,,aci,,rn TFASUlEA PORN TS-IA
Armour)Di'TATE MNRnM Al 1,01 PLF4IINBFD BY nil DEPMIWeT OF LOCAL tnaNNIrNT FP{]CE 11'H.IS11
Gibson County Auditor
101 NMain IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS-
PRINCETON IN 47670 IndividuaLs and married couples are limited to Are homestead sandard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ester for homestead fraud.homestead fraud causes higher tax bills fa all:therefore.
;. HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recebe the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he Lea comidenlial and ran only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create owls that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Burger, Janet L -INC OQP_Fc,7-
904 !winos DR Add.-e55,
Fort Branch IN 47648 p' IO
7619 `r
Janet L Burger ��U`���M
910 Mohawk Dr State Parcel Number Legal Description ,`
FORT BRANCH IN 47648-9508
26-19 18 101-001.156-0//, LITTLE YORK VIL PHASE 2 LOT 14_ _- -I I tl I I ttI1 II ttI 11 I I II1 I1 I Irl I 1 I I t 11 I 1111 I I I I 111 I 11 I 1 I
I PART 2: TAXPAYER INFORMATION
Owner I First Middle Q Last
all zt b.yn�n /) Last
ng Address(number and street,city,state,and ZIP code) — - - _ -- -- — I2 Same as pm adds - --- - -
\D M 04-NO 3L 1Q - 7-�-•\c o c� TN U1cP
Spouse First Middle Last
ceraSe_a — --
Mailing Address(Number and street,city.stale.and ZIP code] _ ❑ Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
sear
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.
6
wn2v, I Signature Date
/
PART 4:ADDITIONAL INFORMATION •
•
I>
/ �, CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
�� State Fwm 5473 (R614-03)
Pres�iibed by the Department W Local Govemment Finance
INSTRUCTIONS: See revcrse side Ior liling inslmcfions.
FORM YEAR
�1 H�C10 �r—� !�
;' f'
1 �� 1� ��_�
MAR � 9 �nna
,
��e� ceNfy�tfiat�on'the,tstdeyof arGh 2
I(VJe) occupi a our principal place of residen e following described real property for which a Homestead P operty' T�dCredil is!here y daimed
❑ I(VJe) o ed ❑ Are buying under ntract
. Have a benefidal interest in the entity that is liable for fhe property taxes on the property and that owns the property or is buying under a conVaU.
I( buyinq on conVacl. Fee Simple owners name
Recordefs ofica where conirad is rewNed
�!-��'x�'.�,-'.��d.E�='��s �.�e4's�!�'.t.�' "���x?: ����
Couny - ' -- Tamship
n ol lhe residential sWCWre w
�+ry u ed uce inmme.
_ ���� �
ca�nty
no�
Township
one �1 �
I hereby certify the above statements are We, wrrect and complete.
Address (n�m6er and sheef, ciry; state, Z/P code)
Ta�ing districj(c�Q; town,
U�e OmPErtY in
immediatety surtounds iha�
County
of
Record number
Page
al property ❑ MobOe Hwno (I.C. 67.7-7) .
is used lo produce income, describe the use antl poNon
s+��'�� � . - .-•K -
•:w":��+..'�'_4�;s�ritiu���'�����'STAN�ARU;DEOUCTION�ALL' OWANCE, >��g?H�„?H,""';�;'-'�=�,�,�`�����;,�'�
20 _ Pay 20 _
Lesser W 1/2 Homestead g
vauanon w E35.W0
Signature of NMilor ' Dala signed