Homestead_Burkett STATE FOR.\I 53569(E BOA) TREASURER FORM TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-8.1
IMPORTANT NOTICE TO.HOMESTEAD:PROPERTY OWNERS 'r
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Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
'eduction 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.
a, :.i! . .1,1r.r* PjARTI {,PROPERTYfINFORMATIONe '. {. - ''_,
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Tasoaver Name Property Address State Parcel Number Leval Description:
Stephen G/Donna S Burkett 10672 S TRI CIRCLE LN \/ 26-23-0I-200-002.095-024 / TWIN OAK 18/17
HAUBSTADT IN 47639
Complete and return to: IiffiIImD]alIIII® IMEMEMOIEMEM I IHDl n
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
3,f Cy PART2:�TAXPAYER-INFORMATION ��� - t - .7'!t
Owner 1 First BRA�D Middle Last
Mailing Address(comber and street,city,state and ZIP code)
Stets property address � �j� 9
►o k7 a S, Cu..�Q.e..�w�. �w.�s—Q I ���(\\7\'la�a�- �`r� I II/
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Spouse First Middle Last
•
Mating Address(number and street,city,state and ZIP code) I Same as property dress
C l S , c1 Rae, 7(03
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
y c.i'eART$ ADDITIONAL INFORMATION: ,,,
FILED
•. MAY 18 ZUII
GIBSON COUNTY AUDITOR
CLAIM FOR HOMESTEAD PROPERTY TAX
,, }� CREDIT/STANDARD DEDUCTION
-1 Slale Fortn 5473 (R8 f 7-07)
Prpstribed by Ihe Deparimenl of Latal Governmen� Finarxx
INSTRUCTIONS: See reverse side /or filing insWcSons.
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AUG 1 1 2008.
� cWe� �S ��'�6 � s L.�..z�S� � �+ o'`a�, ,"
o ca ��yrtify th(;a�tqon the 7sL'da of r�
I(We) occupied as our prindpal pla of residence th following described real property fw which a Homeslead Pfope}� �� i Ts here6yt aimed
�(We) owned ❑ Are buying under contract
Have a benefidal interest in Ne entity that is liable for Ihe property faues on tl�e property and that owns Me property or is buying under a contrad.
If huying on oontracl, Fee Simple ownels name
office where conUacl is recortled
Counry
number Legaldescription
,-a3-ai-ab - ��d
wrtion of ihe residential sirucWre w ihe land nol exceedi
uoperty utiGZad 10 v�duce incorna.
Record number � Pape
(city, lo:vn,
Is Ihe property in ques�ion:
Q� �^ � a� I �Real pioperty ❑ Mobile Home (IC 6-7.7-n
ona (1) acre �hat imm�ately wrtounds Ihal strucWre is used b produce incortre, describe the use and portbn
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Counry Tavnship County Tow�nship
I hereby certify Uie above sFatements are true, correct and complete. Sign of daimant
'ress (nam6araM sheeC cdy, state. and ZlPCOde)
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Land not exceeding 1(one) aae immediately " , - _ ..
surtoundingresidentialimprovemenls. ��) � � � � �
Otherland (z� �
Tcial land (line 7 plus line 2) �g)
Dwelling (4) I . ' �' ,` !' � `t_ � '
Residential imprwements or Mnually ' ` �' �'-`�" � ��
Assessed Mobile I Manufadured Home
Gara9e (5) . _
Other improvements (6) � � ,
Tdal impmvements Qine 4 fhrough line 6) �7�
Tdai value (line 3 phs line n �g)
I hereby certify Me above is We, corred, ard SigrmWre of 0.ssessor Date signed (month, day, yea�
complete.
Veifyirg aclion - SignaWre of �inr pate signed (mmN, day, yea�
2� _ P2Y 20 _
Lesser ot tl2
Hwnestead Valuabon
w
45,000 for 2007 pay 2008 42,000 for 2070 pay 2011
44,000 for 2008 pay 2009 41.000 for 2011 pay 2012 $
43,000 (or 2009 pay 2070 40,000 payable afler 2072
Dale s'y� p�e�d (mwrth, i
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