Homestead_Czoer STATE FORM 53569(R315-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.423-R I
IMPORTANT NOTICE'TO.HOMESTEAD 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
"ruses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
s.4ndard 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 1' INFO'MATION -
Taspaver Name Property Address State Parcel Number Legal Description:
Llewellyn Czoer 650E 1025 S 26-19-32-101-000.555-024 MACK CURTIS 43
HAUBSTADT IN 47639
Complete and return to: I®II[1ll]I1 t]QO]ONIIIM III Knoll EICIIIN ill®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 IL LLll IW BJH
PART 2: TAXPAYER INFORMATION
Owns 1 First Middle Last
IMewel it /l en-41.1 - C17-e-.-r
Mailing Address(nifles and street.city.state and ZIP code)
l Same as property address .
- &5O.E A9.2s 5 t/,.A,b54 + .zn 4176 Ty
.. Last ,
.S C.,/e1 se-5 Tile iv,a c, C-20 ce-1'
Mailing Address(nunter and street.city.slate and ZIP code) I Same as property address
6(SO,E /O.,?S 5 /76-J0 S- + Teti S/74 7 cj"
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 .. -
•
• FILED
NOV 5 2012
r' 7.ih7,"--
GIBSON COUpNTV, AUC;TOA
ia�R
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sta;e Porm 5473 (R2 / 5-92)
INSTRUCTIONS: See reveise side
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f�' i j i' � i,�
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) o ied as our principal plite of resi nce ihe foVowing described real property for which a Homestead Prop
� I'�We) ow ying under coniract � Q_ a�_ v� ���
1
❑ Have a beneficial interest in the entity ihat is liable for t e pmperty taxes on ihe property and that owns th�e,yr��
If buying on conlracC Fee Simple owner's name
Recorders oHice where conVact is recorded
ReCOrd number � Page
- " PROPERTY DESCRIPTION - ' ' � -
Counry � Township Tazing district (ciry, town, fownsbip) _ ,
Parc Inur�ber— ��� Legaldescription .
L
If any portion of Ihe resWen6al structure or ihe larid nat eaceetling one (t) acre that immediately surtountls Nat sVUCture is used ro produce income, descnbe ihe use arM portion
of Ne properry utilized to produce income.
c�'�-i9 3a-/o� �o..TSs-a�
-�-
' - PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Counry Township Counry Township
�_by certify the above statemenis are irue, correci and complete. S� a2ure of daiman2 _
Address (number and svee(. city, stafe. ZIP code)
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
� VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately.
surrounding residential improvementa (� � �
Otherland (p) �
Total land (line 7 plus line Z� (3)
Dwelling (4) . � � . � .
Residential improvements
Garage (5)
Other improvements (6) �
Total improvements Qine 4 through lina � (7) ,
Total value (line 3 pbs line 7) (g)
I hereby certify [he above is Irue, correct, and Sgnature ot Assessor Dare signed
complete. �
Vo.ltying action - Signature ot Auditor Date signetl
- STANDARD DEDUCTION ALLOWANCE � �
19_Pay19_
Lesser of 7/2 Homestead
Valuation or 52.000 S
Signawre of Autliror , ` Dat si neA
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