Homestead_Henson STATE FORM 53569(0.2/3-09) TREASURER FORM TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-8.1
lIMP0 ' A&Str&Irani=1M i iamm lg or) tkignigitny mums
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
'eduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
'Pauses higher tax bills for all; therefore, HEA 1344-2099 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 Local
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
!4Re I: PROPER'T N o RMA e
Taxpayer Name Proverb'Address State Parcel Number Leal Description:
RI Box 149
Gerald P/Furriela J Henson 26-19-19-203-001:241-026 007-00942-00 INDIAN HILLS 19
Fon Branch IN 47648 0-27
Complete and return to: For,
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WI(Q4
- C : INTY AUDITOR, 101 N MAIN PRINCETON IN 47670
fl g3e13 INFORMATION -
Owner 1 First Middle Last
ecc.c\�
C PICX„\ - V\-e2(\3017-1
MaSMg Address(number and street,may,state and ZIP cede) Same as property address
\ * E r1 TO 5 . Vort."ZY-aAAc k- : v 4 rl le q-w
Spouse First Middle Last
•
Matng Address(reanber and street city,state and ZIP coda) Same as property address
Lk o • rl %O 5 • To' t- 6 ro-v.c,\--.-,1JV I--1 "1 le q
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 Signature Date
?
- - PARTS I1 INFORMATION - •
•
IM FOR HOMESTEAD PROPERTY TAX
REDIT/STAIdDARD DEDUCTION
State Form 5473 (R2 / 5-92�
��.� . . -
INSTRUCTIONS: See reve�se side !or tiling instructions.
� . - � . � " � CERTIFICATI
_ FORM 'YEAR
� : � - .: � -.. . "?a
�
�l:
a� � . .
�e� n�����_�— cen ;�mai onw st r �
) occupied as our principal piace of residence the following described real.property o which a Homesi� � �i�i��i (y�ppsla ed
I (We) owned ❑ Are buying under conirac� � � �, . _ ,
❑ Have a beneficial inierest in ihe entity ihat is liable for the pmperty taxes on ihe property and that owns the property or is buying under a contract.
- � � - - � - - CONTRACT.RECORDED �. . � - �� �
If buying on contract; Fee Simple owner's name ., � " . ' '
Recordefs oHice where contract is recordetl Recortl number Page
� "' PROPERTY DESCflIPTION �,
Goury� � . ' �- TownShip ' � . • Tazinq tlisfi t (Ciry,� town, fownship� - : . .
v
Parcel number _ Legal scription .
�0
If any pottion ot the residential structure or Ne land not exceeding one (1) aae that immediatety wrwunds that structure is used to produce income, describe the use and portion
of the property utiiized to praduce income. ,,
-G7U� -(LJ� dT/'UO5(o
PROPERTY OWNED BY CLAIMANT IN OTHER COUN'f1ES
m•nship County
�eby cenify the above siatements are tme, wrrect and complete. I S� nawre of Gaimam
Address (number and streeC Gry, state. ZIP cotle) � �
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL _
� VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately
surrounding residential improvements. (�) �
Otherland � (p)
I
Total land (line 1 plus line 2� (3)
Dwelling (4) -
Residential improvements _
Garage (g)
Other impmvements - (6) .
Total improvemenis Qine 4 fhrough line � (7)
Total value (line 3 pLs line � (g) �
I hereby certity the above is true, correci, and Signaare ot nssessor oaie signea
complete.
�tying action - SignaWre of Auditor Date signed
ii