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Homestead_Dallmier STATE F 433569(92/7•31 TREASURER WP-M TS-IA APPROVED BY STATE BOARD OF ACCOUNTS.2W9 PRESCRIBED BY THE DEPARTMENT OF LGCAL GOVERNMENT FM1AAYT r 6-1.1:38.1 IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS `'Indididuals and married couples are limited to one homestead standard deduction. As the receipt of this '°duction becomes 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 benefit and to provide additional indentifying 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. PART I: PROPERTY INFORMATION Property Address(number and street,city,state,and ZIP code) State Parcel Number FILED 0G - n-v? 'o?a0_aoO. 7J3- O 6 SSEEPP�+2 342013 GIBSON COUNTY AUDITOR PART 2:TAXPAYER INFORMATION • Owner I 4 First Middle Last Mailing ress(number and street,city,state,and ZIP code) I I Same as property address . Spouse First � Middle 42/.//177 Last ia!//a /E� . Mailing ddress(Number eet,city,state,and ZIP code) ❑ 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 gnature Date PART 4:ADDITIONAL INFORMATION Ai INSTRUCTIONS ftw P Rya .ex CLAIM FOR HOMESTEAD PROPERTY TAX - " CREDIT/STANDARD DEDUCTION t / State Fortn 5473 (RS / 70-01) � � �°� Presaibed by Ne DeOartmerrt of Lacal Govemment Finance IN�TRUCTIONS: See 2verse side foi filing ins(ructions. I(We) I!We) oc�pied as o�i principal place oi resid for which a Homestead Property Tac Gedit isiieretiy daimed / _ I(VJe) owned ❑ Me buying under contract � Have a benefidal interest in the entity that is liable for the property taxes on the property and that owns the properly or is buying under a contraG. FORM YEAR Hc,o; � -,- L � �' �� J/ Q I' '� te �'ttr6t on the 1 st r �� If buying on conVact, Fee Simpie ownefs name Recordels oifice whera conirad is remrded Caunty County Tavnship �53-oc� �d�r: C itlantial atrucWre w the land nd b wodum i�rcome. Twvnship one (t) I hereby cerlify the above statements are We, corred and complete. sdress (n4,umberC s�dry, state, ZlPcqd�� _ . � � �I t/ .!� Record number � Paqa Taing � ( Is the P�DehY � Queslion: eal praperty ❑ Mobile Homo (I.C. 61.7•7) - wrtounds �hal SWCNre i5 u5ed to Orodute inmme, desaihe Ne use and portbn County 20_Pay20_ Lesser of 1/2 Homestead Valuption or $6.000 S SignaWreofNidilor / Ix./"\ ,1,, 'I �� I l^19n��—O � �V �