Homestead_Roeder e.
STATE FORM 53569(R3B-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-l.l 22-I.I
fl IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS ,a,
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
illAuction 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 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.
v.
o .%h SPAR 1: PROPER Y INFORMA ION ,,h. `° r;.. :44P?" ,;,:'^
Taxpayer Name frooerty Address State Parcel Number I teal Description:
APACHE DR %
Mark Roeder 26-19-19-204-001.332-026 INDIAN HILLS 86 V
FT BRANCH IN 47648
Complete and return to: IuHlioUJUUU]I MIIIIIME DU[U¢MIl 111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
:::47,AS. - . PART 2:TAXPAYER INFORMATION '1•\.:/r ' ' / ,: i24::-;WTI
Owner 1 First Middle /� S Last
- Ninth- A-- koeaet r
Matting Address(number and street dry,state and ZIP code) I J.Saertlics property address
96o S _Vig E. F.,r a- a ra4 t-4 y % 2(Y, .
._
Spouse First Mlodle - last
Mailing Address(number and steel.city,state and ZIP code) Same as property address
Social Secwiry Number(last 5 digits) Drivers License/State ID Nanber(last 5 digits) Sae Other(please specify in Part 4 Below)
TB..p,... x; .G,:,,,,x, . .C; . rrpRT3:"CERTI6IcAfi10R7• .�-x;.._ic ,A.:-?"<'v '?"�:.P.t!a?it.i-A�t��'r`�w4'�.-.
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 Signature Date
, ,� _, f";.„1:-_-.CE3y .;i:`110!{-PART:4: ADDITIONAL'INFORMATION;%-,fj 5, ';'.A° a Sl=:rtt• a. jrz
• FILED -
• NOV 19 2012
Cn.N
GIBbUN 1.OuNTY AUDITO°
° CLAIM FOR HOMESTEAD PROPERTY TAX FORM Y�R
-� CREDIT/STANDARD DEDUCTION HCio
State Fortn 5673 (R8l 7-07)
��«. � Prescnbed by Ue Departmenl of Loral Govemment Firance
INSTRUCTIONS: See reverse side /w filing ins6uc6ons.
�(We)�! �(LCtC_, y`�[ .Q�K certify Na���heltlt �q1it'March, 20_
I(We) oocupi a�l place of residence Ne following described real property fw which a Homestead Pro�p—eyAy�..T�c Credit/ �i; hereby daimed:
q// liH
I(We) owned ❑ Are buying under contract � ���-
Have a benefidal interest in the entity that is liable fw the property tarzes on the property and that owns th�� � yi�S��FQ�ontrad.
If buyu�8 on caniracl, Fee Simpla rnmers name
Racordere otfice where cmUad is recarded
Counry
Parcel number
Toxnship
Record number � Page
(city, fo:m.
Is Ihe proper�y in queSUan: �
�Real pioperty ❑ Mobile Fbme (IC 6-7.7-n
Narry pqtidn,bf Ure residerNal structuta w �ha land nol pxceeding ofre (1) acre Ihat im�ately wrtounds �hat
of Ihe pr80B�1Y itiGzed to produce incane.
(�lpr/
Counry
Twvnship
County
i hereby certify the above sfatements are true, covect and complete. I Signawre oi aaimam
�(number arid sUee4 state. an Z/P e)
o S y�� �-T `�3.�.��6 Z.,- y
is used ta produce income, de5cnbe Ihe use aM portion
.- .
. . .. . .
�� ..
LarM not exceeding 1(are) acre immediately �.- :-�. �,:y -,'. '.
surtoundingresidentialimprovements. (�� '�' .E�e_i;
-, ,.
Other land iz1 `-��' M1 ,,, ';:
Tdal IarM (line 1 plus line 2) �g)
.':;<� -i.•� ,.
Dwelfirg (q)
ResidentialimprovementsorMnualty '= ?=-�� .. -
Assessed Mobile / Manufacn�red Home �
Ga29e (5) r. �. F `
J'`S
Other improvements (6) . � r� �`. � ��.
;,�;r -
Total impfovements (!'me 4 fhiough Gne 6) �7�
Tolal value (line 3 pl�s lirre � (g�
I Aereby terfify tlie above is We, Gorrett, aMl SignaWre of Pssessor Date signed (month, day, yea�
complete.
Vaitying actim - SignaWre MfWditw Date signed (manth. tlay. yea�
� . • � � � • •
' pay 20 _ 45.ppp for 2007 pay 2008 42,000 for 207 0 pay 2017
Lesser oi 12 dq ppp for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead Valuaton 5
« 43,000 for 2009 pay 2010 40,000 payable after 2012
Signatura of Fwdltw Da�e signad (manth. tlaY. Y��i