Homestead_Smith (13) STATE FORM 53569(R3B-t0) TREASURER FORM TS-IA
APPROVED BY ST.:TE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-3.1-224.I
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS •
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
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. •
itY. .;, .- PARTI: PROPERTY INFORMATION '="1Warl
Messer Name Frooerh'Address State Parcel Number tent Description:
Jack R Smith 300 N CHURCH ST 26-19-18-301-000.043-026 PT SW 18-3-10.40 AC
FT BRANCH IN 47648
Compiew and rearm to: Il IUIUgIi ml UL U0U'V UhIU113''i 1DIMOILM i DWIn
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2: TAXPAYER INFORMATION 74. F A
Owner l Furst j/y� ,s �J/ Middle yL Last
R 1 C- l' 4{S/ N Ip s /I
Mailing Address(number and street,aty,state and ZIP code)
N. rn Same as property address
300 . Ch UY J. s+i F!-: Bran c1. �itt '/7G y 8
Spouse First Middle Last
/1//fr N/ft- yr//
Mailing Address(number and street,aty,state and ZIP code) I 1 I Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number(last 5 digits) bats Omer(please specify in Part 4 below)
rtMrr+et , • F • �" :--i 'PART`S:CLFCftFllitA'f10N:-- {•._-- °r—`` ,, e. m
Each undersigned certifies,un•e penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to receive the
homestead standar educti. onithis property. Each undersigned also understands that,by claiming additional homestead deductions unlawfully,he or
she may b liable f ack to ela d substantial financial penalties.
Owner 1 Sig e Date
FILED
• NOV 15 2012
Mme\\ yv\
GIBSON COUNTY AI inn-no
�, ,�� CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
`., ` State Fortn 5473 (R4 / &00)
� INS7RUCTIONS: See reverse side (orfiling inaWCtions.
FORM '` Y�R -
HC10 � ���
I(We) certify ihal on the 1st day of March, 20_
I(VJe) ocwpie as our prindpal place of residence the following desaibed real property for which a Homeslead Pr�Talc �eQ�i{��ereby daimed:
�I(We) ow ed ❑ Are buying under contrad / (/,/� n
rlave a benefidal interest in the entity that is liable for the property taxes on the property and that owns �property-s�{S ¢uyyjg,uPde�ac��trad.
If biryirig on contract, Fee Simpie owneYS name
RecordeYS ofFce where contrad is recoNed
Counry
Twmship
Tadng tlisVicl (city, fown. townshiP)
Record number . � Page
�'�—mber_ _ ��' _ + ILegaldesaiption ( � / v'`/V � U � � ^/O t �O I Il..�
�Vl/v /V y� (
�
II any portion ol ihe reziAential sW dure or the WnA not exceeding one (1) acre thal immetliatey surtounds that struUUre is usetl to produce income, describe Ue use aM porUm
ot the pmpe�y uUlized to produce i�ome. - � � -
I hereby ceNfy the above statements are We, corred and complete.
�'ress (number and streeL dty, stafe. ZlPCOde)