HomeMy WebLinkAboutHomestead_Brundage STATE FORM 53569(RSB-10) TREASURER Focal TS.IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC61.1S2-8.1
. IMPORTANT NOTICE TO.IIONIESTEAD PROPERTY OWNERS .- °
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
uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
SL ndard 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.
. PAR7`t: PROPER l''INFOIL�tAT10\
Taxpayer Name Property Address Slate Parcel Number Legal Description:
Phillip 1/Monica L Brundage 10237 S QUAIL CROSSING 26-18-36-300-002.066-024 HUNTERS CROSSING 2 LOT 3
HAUBSTADT IN 47639
Complete and return to: I1111IIf101f;IlDIllffl r0�m III MID lI1� �IW111111d0
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 tlB MID IB 1W IIf IlW1
- - 1, PART 2: TAXPAYER INFORMATION .-
Owner 1 First Middle Last
PII1lip ( hr0itir(o(2e - AD ry i�a9e.
[aging Address(number and steel city.star nd ZIP code) I I
property address
. /G2-3 3- QucA; ( Gyros'I I. r, �G�S-`GOO- q%/ p
- First / Middle Last
fl0�oica-troidO h2GLk (3rim- da
Mailing Address(hunter and street.city.state and ZIP code) I .1 rre as property address
(023 - 6Oc;i( (1(6 511- .- thubs-1-c.c( .-I id '(3'1
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 • - - .
. FIL ED
• NOV 7 2012
GIBSON COUNTY AUDITOR
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Steta Fortn 5173 (R6 ! 4-03)
Prescribed by Ne Department ol Local Govemment Finanee
INSTRUCTIONS: Sea reverse side !or �lirg insfi�Uions.
�;?�;,-'�S-�1'i'��„'''-.'<''�*c_'�'� f,,.-�t"��n.'-�,es'y�"ys:�+'.'�f"%CERTIFIC ON�STATEI
s--�- � -� _..
�(we) 7
I(We) occupied as our rincip I lace of residence the following described real property
�� EAR
FORM �
�I _
_ certity'��� tqg �day of March. 20_
Homestead'Property Ta� C��fJf'ereby daimed:
+(We) owned ❑ Are buying under contract G�gSON COUNT
Have a benefidal interes� in the entity ihat is liable for the property taxes on the property and thal owns the property or is buying under a contracl.
I( buying om m�traa, Fee Simple ownets name
Remrders olfica whaza conVaq is recaMed
County
Twmship
vv7 -v�xc�[� F� -� I S�(tast.fl� l�
tl any portion of the residenllal sWCture w the landny�qpd ing one�hat
of the property uti¢eE tn produce i�xome. / 7C G`�O
v �
�/n ' �"1(a'-"]/)//�
Record number
Tating
Page
I Is/M1e pro rty in queslion:
/
eal proparty ❑ Mabiia Hwno (/.C. 6L7-7) .
surtounds that sWCture is used lo protluce income, describe Ne use antl portbn
�����s iw..
�AS.�SES�SORUSE,ONLY ���'���TVAL E`"�'�v AATE00%OF"TTV { HOVALUE�`D du ��"'� �VALUE"-$`n�.�"'�a�`�
'"� U .�ti.Rt� rS'a-.... ....7a....,� ...3., , i0$•":�. ,-,. .�� .��-:�^�is,... rz
Land nol exceeding 1(one) aue immediatety �.,t� tt� ������,��,�"
surrounding residentlal improvements. (�� m� r:� '�" `'T°s t �i
L-�§��"��e,�..�7�a:
Other land (2) ���: ��� Yx �e
�+4�"€�i��3
TUaI land (line 1 plus line 2) (3�
Dwelling i4) ��"'���� �y.�.•'��"�
Residentiet improvements or Mnuaity � � � '��'��
Assessed Modla / Manufadured Home Garage (5) ��{� � '✓�%s . `���
�T.h.
Other improvements (6) '��=' f s������
�`F.a. `�P��-.'�1.�.�'
Tdal improvements (line 4 through Ime 6) (��
7dal value Qine 3 plus line n (g)
I hefeby certi(y Ihe above is We, corred, and Signature of Assessor Data signad
amplete.
Verifyi�g aclion - Signature af Autlimr Date sgned
20u�ay 20 S,J �
Lesserof 1/Z Homestead
vauaUOn w E35.000
5
Dale si ed
..5�"- 5' -cJ6
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