Homestead_Braselton SIAM FOISt M lR]-t Swl TREASURER PoR4 73-IA
ArrWA'EO BY SIAM ark.Eporsormi'IS9.0 PREYAIBW BY Mt DEPARTSQSIT OF LOCAL rossRYM63.rBs\CE IC bl.l_LI
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 IndiriduaL and married couples are limited to one homestead standatd 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.
• AEA 1344-2009 requires taxpayers who receise the homestead standard deduction to verify that they are eligible to receise the
benefit and to provide additional identifying information necessary to alloy county government to better monitor homestead
filings.This information will be kept confidential and can only he accessed by authorized county officials.'the Department of
Luca! Government Finance will use this information to create touts that will help count'officials eliminate homestead fraud.
• PART 1: PROPERTY LNFORMATION
Taxpayer Name Property Address
Braselton, Quentin J/ Karen S 1
Rr?Box 59c
Ilauhstadt IN 47639
3399
Quentin J/Karen S Braselton
R2 Box 59 C State Parcel Number Legal Description
HaubstadtIN 47639-7860
ltlttlltttltlltttr�lIllltt�ttt��ttlttllttlltttirrlI�� I I 26-23-02-400-001.883-024 004-01683-000AKRIDGE EST 1
D-10
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2:TAXPAYER INFORMATION
Owner I /� First '(� L Middle Q 11 Last
OLletlliVI V ackso ✓( ()eC.sel IOVA
eg Address(number and street,city,state,and ZIP code) 121 Same as property address
/01S70 S. Dakr ' cdse Cst {1G tit 6S1adi-, EN 24639
Spouse First Middle I Last
KGretet Sae Erase (-to
Mailing Address(Number and street,city.stale,and ZIP code) ®Same as property address
X08?0 S. Ockr Ids e Es {-. , I4ck6s4-a di- , r Li ? 63q
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
� s,,.E o
i `
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1fi
CLAIM FOR'HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side !or tiling instructions.
_ FORM
HC10
YEAR
��. CERTIFICATION STATEMENT
I(We) �t- %D � u C�/� certify that on the 7st day of March, 19_
I(We) occupied as our principal place of residence the following descnbed real property for which a Homestead Pro re�h�claimed:
� �i{
❑ I(We) owned ❑ Are buying under contract �`C p`
❑ Have a beneficial interest in the entiry that is liable for the property taxes on the pmperty and that owns the pro�rty oris �tiying u�e�r a contract.
6 20
CONTRACTRECORDED
If buying on conVac4 Fee Simple owners name
Recorders otfice where conVact is recorded ✓ r+` V_� � � Page
PROPERTY DESCRIPTION
Counry � Tmmship nO- Tauing disind (ci to wnshipJ`�J� � �
�di�7 ' W/SCYI .
Parcel number Legal descripuon .
��V
If any poNon of ihe resitlenlial structure or the IarW rwi exceeding one (1) acre that immetliatey surtountls ihat swcture is used [o produce income. tlescribe Ne use antl porlion of
ihe properry utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
Signa` re of claima � p,
�areby certify the above statemen[s are true, correct and complete. �� -
Atltlress (number and street, ciry, stale, ZIP cnde)
R.R2 Bo� . 9C u65fad . rN K�639
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately ��� �
surrounding residential improvements. '
Oiherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
ResideNial improvements � �
Garage (5)
Oiher improvemenis (6)
Total improvemenis (line 4 through line 6) (7)
Tota� value (line 3 plus line 7) (8)
I hereby certify [he above is true, correct, and Signature ot Assesor Da�e si9ned
complete.
Veritying action - Signamre ot Auditor Date signetl
�•: � STANDARD DEDUCTION ALLOWANCE
19_ Pay 79 _
sser of 1/2 Homestead 5
Va atio� or 52,000
Signature of Auditw Date signed
, 3-/�-Od