Homestead_Wagner STATE FORM 5;569(RA-10) TREASURER FORM TS-IA
APP$17ED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1 2222-5.I
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS 0.
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
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.
PARTI: PROPERTY INFORMATION e
Tamer Namt Property Address $late Parcel Number - Legal Description:
Barton L Wanner 703E STRAIN ST 26-19-19-102-000.080-026 PT NW 19-3-10.29 AC
FT BRANCH IN 47648
Complete and return to: I lIl B1flnp7 en11e anm It1 con•. n not n
ICI;DtIaBOBtlgQun�e:VE18�m11�ID{uuue�u�G�ut�Vu
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
.. • . ,PART 2: TAXPAYER INFORMATION.
Omer 1 First
Lou ; - Middle Last
r o,� L 5 V �0.one r
Mating Address(number and street.drys state and ZIP code) rt7 Same as propnty address
Spouse First Middle Last
Mailing Address(number and streel city.state and ZIP code) Same as property address
Social Security Number(last 5 digits) Odvers License/State ID Number(last 5 digits) Stare Omer(please soecay at Pan 4 below)
a P• .CE , FIG
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.
Omer 1 Signature Date
� . _ ,
Nov 13 2012
GIBSON COUNTY AUDIT OR
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDR/STANDARD DEDUCTION
Sfete Fpm S173 (R6 / 4-03)
ReaciEed by tlro DeparNierrt d Local Gouemrmnt Finaxe
INSTRUCTiONS: See ie�ares a6ds brl6tp iubuc8'onc
I (we) � Y\ Y
I(We) occupied as our principal place of resi ence the follow g described real property f which a F
❑ I(We) owned ❑ Ne buying under contracf -
' Have a benefidal interest in Ne entlty thal is Iiable for the property taxes on the property and Ihal
�r nuyiny on convaa, Fee simple owners narne
Recordefs olfice where conVaC is remrdeC
Couny
Tamship
,�l � i �`���i.�xu��.r�i �1
� y porfbn ol Ne resitlentlal sWqure w tha lan not
of the property ulii¢etl tD produce incpme.
County
Toxnship
1 l -r � .� -� v�
one (1) aae that immetliatety
I hereby certify fhe above statemenLs are We, corred and complete.
Addre (number arW stree�, dty, afafe, ZIP cade)
' %G�y• �: S+/U�n Sf. Fi. CimnLl�. �'itJ U7G
Land nol exceeding 1(one) aue immediately
surrounding residential improvemenfs.
Other land
Tdal land (line 1 plus line 2)
Dwelling
�Residential improvements or Mnua�y
As�d Mb6Ue / Manufa�red Hortm Garage
Other improvemenls
Talal improvements (Irne 4 through line 6)
Ttfal value (line 3 p!'s line n
I hereby certify the above is We, correct, and
complele.
Vsifying actbn - SignaNre oflwtlimr
(�)
1z)
(3)
�4)
(5)
(6)
(�)
(8)
SignaWre of Asxssor
County
(rity, town, townshiP)
FORM � � YEAR
HC70 �
r��the 1st day of March, 20_
�operty Tac Credit is hereby daimed:
p�or is buying under a conVact.
Y AUDI70R
r � � � : a ° �" � ,i # � � : � h� ' ' F
Record number Page
�in tion:
�property ❑ Mobde Homo (LC. 6/.7-�
that sUUCUre i5 used to produce income, describa Ne use and portion
Dale signed
Date signed
>. -•�:"t:y �nf;s�Yi�',+'^. � i - r3!`Y'Sx .w . w,i"=.
--. � �.a�4.�� sYe°.,�1�-.�,ra7� _ .._ xi'�'.��'�'--STANUARU:DEDUCTION'ALCOWANCE#�xi�&i«���. �i'T�'���.��+'r`#.s'.c-?5"i��.��'����e�`�'�K
20_Pay20_
Lesser of t/2 Homestead g
V9ue0on orf35.000
Sgnaturo oflwditw " Date signed