Homestead_Meny (5) STATE FORM 53569(R3/8.10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FlNANCE7 6-l.1-222-8.1
IMPORTANT NOTICE-TO HOMESTEAD PROPERTY OWNERS o
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
auction 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.
PAR 1: PROPER Y INFO MA lON
Taxpayer Name Property Address Slate Parcel Number Leeal Description:
Margaret Meny 3095E 1300 S - 26-23-14-400-001.752-024 PT,SW SE.14 4 10-3.-33 AC -"
EVANSVILLE IN 47725 --
Complete and return to: f®1IQuifDuIlDIUIUI11m®QDIIIIME EI
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
i PARr 2:TAXPAYER INFOIUTATION
Owner 1 First ' Last
a,f-G7� ar, e
fitre- y
Mailing Address(n and serest,dry,slate and ZIP code)
I I Sane as progeny address
AGO 2s� G'3ooS ?
Spouse First Middle Last
Mailing Address(number and street city,state and ZIP code)
Same as properly address
Social Seamy Number(last 5 digits) Drivers License/State ID Number(last 5 digits) Sum Other(please specify in Pan 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 I Signature Date Telephone
/ I - / ?- lam (
- -
PART 4:ADDITIONAL INFORMATION
•
f� � CLAIM FOR HOiNESTEAD PROPERTY TAX
Yr� CREDIT/STANDARD DEDUCTION
Swte Form 5473 (R2 / 5-92)
+ ,�i
INSTRUCTIONS: See revefse side lor liling instructions.
,. . � ..-- - � . � �--::cFan�rer
FORM
HC10
YEAR
� rWe) � � certity thai oe A7snt d�Ia�y of Marth, 1r�
�e) occupied as our pr pal place of re ce the followinq describ real property tor which a Homestead froper~ty�T� 6teait �by daimed:
(We) owned ❑ Are buying under coniract , � `�
❑ Have a beneficial interest in the entiry ihat is liable for the property taxes on the property and ihat owns t��t���der �onSi�ct.
. . . . . _. CONTRACT^RECORDED - . �� f.. - - °. � ,:..-��; . _ .
It 6uyirg om m�trad, Fee Simple owner's name
Recorder's oflice where conirad is recorded Record number Page
PROPERTY DESCRIPTION
Counry Township Tasirg d� "ct (dry, rown, township)
Parcel number Leg de nption
0� -a� -co � - -/0 3
If any portion of the resbential struaure or the IanE noi exceeding one (1) ave that immediatey surtounds that structure is used to protluce income, descriDe Ihe use
of the property utilized ro produce income.
��-�3 �� D-OD��S�-Q�?�
� � PROPEHTY OWNED BY CLAIMANT IN OTHER COUNTIES �
Counry Township Counry Township
�reby certify the above statemenis are true, correct and complete. '�a� of aaimam
ACdress (number and slreeC dry, slafe, ZIP code)
ASSESSOR USE ONLY .. TRUE TAX ASSESSED HOMESTEAD ,� NON-RESIDENiIAL.
� . � VALUE VALUE VALUE , VALUE _
Land not exceeding 1(one) acre immediately � _- -
surroundingresidentialimprovements. (�� • ��-"" �
Otherland (p) " . � �
,; u. •
Total land (line 1 plus line Z� (3) -
Dwelling (4) , � �
�..
Residential improvemenis . . -
Garage (5� _ - �
Oiher improvements (6) �
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line 7) (g)
I hereby certify Ihe above i5 irue. corrett, arM SignaNre of Assessor Date signed
complete.
�iryirg action - Synature of Auditor Date sgned
19_Pay79_
Lesser of 1/2 Homesread
Valuation or $2,000
S
signed
�y A�U�'�_ r�