Homestead_Boling STATE FORM 53569(R3/8-10) •TREASURER FOR.M TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 - PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC61.1-22-8.I
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. . IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
fiction 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 betiefi4;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 authoriiedl county officials. The Department of Local
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
PART1: PROPERTY ;FORMA ION ,
Taxpayer Name Property Address State Parcel Number Legal Description:
Larry J Boling 10725 S 525 E 26-23-0I-200-002.070-024 TWIN OAK 5 V
HAUBSTADT IN 47639 t�7lryr
Complete and return to: IQ1100]D000 fi1101111mBm100111mQ'��uIrnl®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 t1 {l Il
' • PART 2:TAXPAYER INFO2\IATION - . .
Owner 1 First Middle Last
.41 r O let/ BO A
Marling Address(number and street,dry,state and ZIP e) U _)/Same as property address
•Spouse First - Middle Last
/el Pepe do!In('
Mang Address(number and street.dty.state and Zli/c de) (�J
Same as property address
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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.
rimer 1 Signature r Date
'�:- PART 4:-ADDITIONALItNFOR\IATION
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
Stete Fotm 5/73 (RB / 4-03)
ResaibeE M Me Depaihmnt d Loral Govemment Fina`xe
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FORM YEAR
� c�
�aN 1
� �e) . . certify (fiat�oar��isT'dz�i o( March, 20_
I(VJe) occupied as our pn place of reside the following described real erty for which a Homc��8�►6�2P@fJF�f�ZrqQjb��eby daimed:
❑ I(VJe) owned ❑ Are buying under contract �
'� Have a benefidal interest in the enGty that is liable for the property taxes on the property and fhal owns lhe property or is buying under a wntrad.
If buying on conirad, Fee Simple owners name
Recorders ofice where conVad is recorded
Counry
�.. � Tomship
Ta�ing district (ciry, rown, township)
Record number � Page
�ceJ,!_f2S�� �W ( L��/�/�,�DLY� 1�KA` S I Is Ne Pmperty in question:
❑ Real property ❑ Mobile Homo (I.C. b1.7-n
xi af the rasidentlal sWCfure w the land not axceeding one (7) ace Ihat immediatety wrrounds that sWUUre is used b produce incane, describa Ne use and portlon
erty utilaee tn produce income.
�ve�i��i'�n
