Homestead_Blunck STAT=.FORM 53569(R3/8-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-222-8.1
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
',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.
PART11-PROPERTYINFORMATION
Taanaver Name froperl Address Slate Parcel Number Leeal Description:
Rex Al Marilyn Blunck 1932 S LAKEWOOD CIRCLE 26-13-20-200-001236-004 LAKEWOOD HILLS LOT 2
FRANCISCO IN 47649 C-1-D-2
Complete and retF.rn m:- 1W1���IQJIIII�U4IglI1I�IlI ��II �IIIIIIlI�C1��ll [l��
•
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
•
PART 2:TAXPAYER INFORMATION .
Owner 1 First Middle Last
REA nNDrEI)l BLtNck
Marling Address(number and street,city,state and ZIP code) I as property address
*trams
Spouse First - Middle Last
M A'REL Y NFU — B LU N GIc
Mailing Address(ember and street city,state and ZIP code) Same 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 I Signature Date
•
1R
J
� nn4
Y� t CLAIM FOR HOMESTEAD PROPERTY TAX
i,
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 15 92)
INSTRUCTIONS: See reverse side for filing instructions.
5 e5�
t
°
NOV 18 1998
""-';CERTIFICATION STATEMENTsd
I (We) e_,?, 9Mt 19
t (We) occupied as our principal place of re idea the following described real property for which a Homestead Property Tax Credit is hereby claimed:
,01 (We) owned ❑ Are buying under contract
LI Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
_.CONTRACT - RECORDED.': It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY. DESCRIPTION' ,, :` r,e -= .+ ° °• _. _, ,-, -, :. -
Coun
Township
Taxin istdct ( ,town, townshi )
Township
' Hereby certify the above statements are true, correct and complete.
Signature of claim t
cwt
Parcel number
Legal description
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
- - `PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
County
Township
County
Township
' Hereby certify the above statements are true, correct and complete.
Signature of claim t
cwt
1A 1� r ess (number and street, city, state, ZIP code)
fza-o- I I n-,> 2G v- 1- -
'.
TRUE TAX
ASSESSED
HOMESTEAD • --
NON -RESIDENTIAL` -'NON
< ASSESSOR USE ONLY
- -- - -
VALUE
VALUE.
VALUE,--
,
- -VALUE_`
Land not exceeding 1 (one) acre immediately
_ -
surrounding residential improvements.
(1)
- -
Otherland
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
-
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
verifying action - Signature of Auditor
Date signed
- - STANDARD DEDUCTION ALLOWANCE'= -
19_ Pay 19_
Lesser of 1/2 Homestead
$
Valuation or $2,000
Signature of Auditor
Date signed