Homestead_Robicheaux STATE FORM 53569(R3l&10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC61.1-2241.1
IMPORTANT NOTI'C«E TO HOIVDE•STE'AD PROYPPRTY OWNIEBRS
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
auses 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 Local
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
PARTI: PROPERinr INFORMATION • .
Taxpayer Name Property Address State Parcel Number Leeal Description:
Derek P Robicheaux 307 N'Locust 26-18-13-403-000.902-026 POLK ADD 2
Fort Branch IN 47648
Complete and return to: 1111111[111111[1111111111111111101110101111111111101111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
• Ptailir[e CM IN FORM A AV MS
Owner 1 First Middle Last
)2acK O,4UL Rook% x
Mailing Address(number and street,city.state and ZIP code) I Same as property address
30 7 !,
,...rsa First Middle Last
X4/t/ilE 1/4,5". 7527 Xi �AS/GHga zcC
be
Mailing Address(number and street,city.state and ZIP code) Sarno as property address
Whathilt C u0189 . .
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 deductio in this property. Each undersigned also understands that,by claiming additional homestead deductions unlawfully,he or
she may be liable for bac t.-es and substantial financial penalties.
Owner l 5,--urr / Date
MtlIMO3Anffigagla INFORMATION ... .
FILE "if
•
�M�AR 7 1013
GIBBON COUNTY AUDITOR .
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDR/ST/WDARD DEDUCTION
S1eM Fpm 5/73 (R6 / 1-03)
P,eaWbed by the DeOerCnerM1 of Locel GovemmeM Finaxe
� i,vsrRUCnoNS: s� re�o mdo a�:�mu�ao�o.
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FORM 1'EAR
H10�
.1L FS /
NOV 2 S
I(We) /lSX!!-iD � Y`� %�`���_(y,(/,(.e_, 7[U/f/L'� // i e X certify tha-t on Uu�1s�a�t March. 20
I(We) occupied as our principal place of residence the tollowing descnbed real property for ich a Homestead�Properfy:7ac�C'redft.LstMere6y daimed:
❑ I(We) owned ❑ Ne buying under contract
' Have a benefidal interest in fhe entity that is liable for the property taxes on the property and �hal owns the property or is buying under a conVaU.
If buying on coniracl, Fee Simple ownets name
Remrdefs ofice whera mntract is recaded
County
Tavnship
fown,
erwi numcer � i p PfO� i�
o��-e� 96a - �� o�e °�d� � = e
If any poM1ion of Ihe residential sWClure or the land not exceeding one (1) aae that immediately wrtounds that sW ctu
of the properry ulilized lo produce income.
County
I hereby certify the above statemenls are W e, corted and oomplete.
County
Remrd number � Page
� woo�m ❑ �+1obile Homo II.C. 6/./-� .
is used b D�uce income, desttibe fhe use antl portion
. �Twvnship
�dreu(��bD�s�la� �dI�OPG.IST 5T, �T. �Kl�-NCi-i� SI� �—f-��`t'b I