Homestead_Hirsch (10) STATE FORM 53569(R315-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT PENANCE IC6-I.1-22-S.I
IMPORTANT NOTICE TOBONIESTEAD 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
s u dard 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.
' t711fbTitl Elf •N /.
Taxpayer Name Property'Address State Parcel Number Leaal Description:
Gary Hirsch 10247 S 450 ' 26-18-32400-002.193-024 PT SE 32-3-11 .97 AC
CYNTHIANA IN 47612
Complete and return to: I II1IIUh1f ll02f UO1m®®li IUflll l®1I wpm
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 LIl uJ
PART 2:TAXPAYER INFORMATION
Owner 1 First Middle / Last
y701ry Aat �Gy � � •�ir5A
Mailing Address(hunter and str t.dry,state and ZIP code)
Same as property address
10247 S Q SO ti/ Cynf-IN ranU--k / Z
Mitltlle Last
MaStic Address(number and streeL city.state and ZIP code) EiSame as property address
Social Seamy Number(last 5 digits) Diver's License/State ID Hunter(last 5 digits)) St • OBMr(please specify in Part 4 below)
PART 3: CERTIFICATION"
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
( )
•
Prim 4 ALtuI 11111?IU!NI.712TI �TION
.,
DEC 27 2012
•
GIBSON COUNTY AUDITOR
' CLAIM�FOR HOMESTEAD PROPERTY TAX
° CREDIT/STANDARD DEDUCTION
t State fwm 5673 (R6 / 4-03)
' Presaibed by the Department af Local Govemment Finance
INSTRUCTIONSr See reverse side for filing instn�ctions.
�� FORM
HC10
YEAR
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I(VJe) occupied as our prin 'pal pla residence the following descnbed real property for which e Homeste rop d is e r�Y9eimed:
ri I(We) ovmed ❑ Are b' g under contraci
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Have e benefidal interest in the entiry that is IiaWe for Ne property texes on the property and that owns Ne prope �'r is bu g a conVaa.
If buyinp m conVSq, Fee Slmple awneh name
Recarders offlce where conVaq
To�nship
P����•0 �-Q,11 �i 3����`��o�
tl any pMion ol the resiCenCal sWCture or Ne IaM rwt exceedinp one
d the propaRy utllized to produce income.
distrid (cify,
immadiatey surtwnds Nat
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Y AUDITOR
Racord numbar � Pege
� o�c�m ❑ Mobile Home (I.C. 6�7.7-n
is use0 to produce Incoma, desctiba Na use and portion
20 _ Pay 20 _
Lesser of t!2 Homestead
ValuaEOn w 535,000
$
_w �. -ir g� "�'0 . .