Homestead_Brown (3) •
STATE FORM 53569(818-10) TREASURER FORM TS.IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-41-22-8.I
' IMPORTANT NOTICE TO7HOMESTEA'D PROPERTY O%1/NE RS
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
auses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
4
Bard 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: PROPER Y. t'FO'DMA ION- ,
Taxpayer Name Property Address Slate Parcel Number Legal Description: ,
Stewart A/Tina M Brow 11897 S 50 Brown 26-22-12-000-001.097-024 PT W SE SE 12 4 I I .575 AC
HAUBSTADT IN 47639 D-9 11'
Complete and return to: In 07 H DE1111 f U1l 01011161UmJ�W OU
__ __ _ _ GIBSON CO uN-ry AUDITOR, IOI.N MAIN PRINCETON.LN,476 70 __ _ - W -- __- --
. PART?:_-TA�CPA1'ERL\FORL�IAT1O?
Amer I First Middle Last
S Oa r7- 4/PYe/ nd.g. v- 6 roedci
Mailing Address(number and street city,state and ZIP code) f t/�yrp as properly address
First Middle Last
%i�a /7YItch /41 iii6roa)n
Mailing Address(number arid street.dy.state and ZIP code) rte as property address
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 1 Signature Date
PART 4::ADDITIONAL INFORMATION h.
FILED
111. NOV 19 2012
GIBSON CCUNTYY AUDI I OR
�-" f CLAIM FOR HOMESTEAD PROPERTY TAX FoRM - YEAR
i;a�': CREDIT/STANDARD DEDUCTION. ' HC10
�,`;�� State Form 5473 (R2 / SA2)
�eu �q�y�
INSTRUCTIONS: See reverse side !or liling instructions. � . I�'i �� �
1L � �-�-
I 1We) _ _ I�� /1 (/YI.C'�, /� 1/�.�.Clz��'1 certify ih n the 1st day o arch. 7
��
a) occupied as our principal place of r� esid ihe following described real pioperty tor which a Homestead P erty T Cr it is reby e
L� I(We) owned ❑ Are buying under contract . �B�nh p�t TY A!!�ITOR
❑ Have a beneficial interest in ihe entity ihat is liable for the property taxes on the property and that owns the property or is buyin9 under a contract.
� - •n . .. CONTRACT RECORDED . -� ' - '
tl buying on coniract, Fee Simple owner's name . •
Recorder's ottice where coMraa is recorded Record number Page
� � � � � ' - PROPEHTY DESCRIPTION � �
Counry Township • - � Taxing district (ciry, rown, townshrp) . - � �
Parcel number Legal tlescription
_ _ a- -� � , J 7J
It any portion of the residential st ucture or the land not exceedi one (7) ave that immediatety sunounds that strucNre is used to protluce i�ome, tlescribe ihe use and portion
of the pwperty utilized to produce income.
r. .
- - cr�-�. v -�a
PROPERTY OWNED BV CLAIMANT IN OTHER COUMIES
Counry Township County Township
�eby certify the above siatements are true, correct and complete. Siqnanre f ciamam O
Atldress (numberantlstreet, ciry, s1are. ZlPcode) n„/ n ��
iC�/U �
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
. _VALUE - VALUE, VALUE - VALUE
Land not exceeding 1(one) acre immediately -
surrounding residential impmvements. (�) � - '
Otheriand (p)
Total land (line 7 plus line � (3)
Dwelling (4) - � ,
Residential improvemenis
Garage (g)
Other impravements (6) '
Total improvemenis (line 4 thioughlina � (7�
Total value Qine 3 p6s line � (g)
I hereby certify the above is lrue, Correct, and Signature ot Assessor Date signed
complete. �
Verityirg action - Signature of Audi;or Date signed
�
- � STANDARD DEDUCTION ALIOWANCE
79_Pay19_
Lesser of 1/2 Homestead
Valuation or 52.000
S
SgnaWre of Audltor Dare s'gned�
� _