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Homestead_Lashbrook STATE FCRM 535691A:17-on TREASURER Fc*•ES-IA APPROVED BY STATE BOARD OF ACCOUNTS.!039 PRESCRIBED BY THE DEPARTMENT OF LOCH.GOVTZKMEXT FA'Ati£C&I1_4.I . IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS Individuals and married couples are limited to one homestead standard deduction. As the receipt of this 'e ,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 indentifying 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. PART I: PROPERTY INFORMATION Property Address(number and street,city,state,and ZIP code) State Parcel Number FILE it, Id — c33- ©9- v3Gb- en. ‘ /9- 00? `' SFP20Z013 atmeifizir • GIBSON COUNTY AU OR PART 2:TAXPAYER INFORMATION Owner First Middle �7 Last nel--g Mailing Address(number and street,city,state,and ZIP code) ❑ Same as property address Spouse /��y/�//1�/"((-1�� First Middle / Last Mat mg Ad ber and street,city,state,and ZIP code) ❑ Same as property address L 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. `O4ne I Signature / Date III . INSTRUCTIONS Mv al) R e. ?K CLAIM FOR HOMESTEAD PROPERTY TAX - " CREDIT/STANDARD DEDUCTION t•a � State Fortn 5473 (RS / 10-01) Presaibed by Ne Department of Local Gavemment Finance INSTRUCTIONS: See reverse side lor �ling inslructions. FORM HC10 YEAR �(We1 � �, ���,��,�(/h,(L����C� r��h� 1st day of March. 20— I(We) occupied as our prindpal place of residence ihe (ollmving described real property for which a Homeslead Property Tac Credit is hereby daimed: � I(VJe) owned ❑ Are buying under contracf � iHave a benefidal interest in the entity thal is liable (or the property taxes on ihe property and thal owns the properry or is buying under a contraU. If 6yMg om m�Uacl, Fee Simple ownefs name Recoidefs ofice whera conVad is recorded County Toxnship H any poM1ion ot Me resiAentlal struqure w Me land not exceeding one (1) aue that immeE of ine Moperty util¢ed tn yaduce ixome. // Gl�lr ' c%� -D % y�UO - OGY�. �o/% ��T Remrd number 7acing dislrict (dty, fown, fownship) Page Is tha property in question: ❑ Real propeM ❑ Mobile Homo (I.Q 61.1-n . �unds that sW Uure i5 used b produce incwne, destribe the use and portion 20_Pay20_ Lesser o( 1f2 Homestead Valuation or $6,000 � � $ Signawra ol AuditoF � _ 1' {� . n e � \ I Date s�netl /� � w i