Homestead_Meyer (5) STATE FORM 53569(RYS-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE ICSI A-22-5.1
IMPORTANT NOTICE TO'HONIESTEAD-PROPERTY--OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
dibuction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
auses 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 goyernment 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 twill help county officials eliminate .
- • - homestead fraud. - •.
• PART :; PROPER, INFtATIO\ /Y
Taxpaser Name Property Address State Parcel Number Leal Description: V
Keith R Meyer 2850 W 1 125 S 26-22-10-200-000.708-024 PT NE 10 4 I 1 3.535 AC
HAUBSTADT IN 47639
Complete and return to: 1E11100I0]0001II III N m HI 111101gmmmfI0
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
. ' PART 2: TAXPAYER INFORIMIATION • - ,
Owner I l First Middle Last
1<E 1 / / . R /i2on7/9 , . 4999 K
Mating Address(number and street,city,state and ZIP codel.
9750 � . / //96-5
I Same as property address
�- . . .
Spouse Firs) . . Middle fast
Mailing Address(number and street.city.state and ZIP cede) Same as properly address
Social Security Number(last 5 digits) Drivers License/State ID Number(last 5 digits) Dee Other(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. •
Ow er I Signature Date
PART_4: ADDITIONAL-INFORMIATIO,N: -
} CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (RB / 4Qij
Prestnbed by the Department of Local Govemment Finance
INSTRUCTIONS: See revcrse side Ior liling lnsWc(ions.
ORAI� YEAR
� HC1Q�
�/
OCT 1'� 2003
I�e) occu ied as our rinci al lace of resi nce e followin described real ro e for which a Homesteed roJ ert' Tac�C �it��s h� e� da med:
(w ) P P P P 9 P P rtY P Y Y
❑ 1(We) owned ❑ Are buying under contract
� Have a beneficial interest in the entity that is liable for the property taxes on ihe property and that owns lhe property or is buying under a wntraU.
I( byvig on wnLaq, Fee Simple owneh name
Remrders ofice where contrad
Tamsnip
P ce num +r `_�O ��OI Legal descripUOn
4sV
If any potlion of Ne resitlentlal sWdura w Ue land not e:ceeding one (t) acre Nat
ot the properry utilized b produce i�ome.
� 1J_��l—
Record number
town,
the oroceM in
Page
_ l uyneal property ❑ Mobile Homo Q.C. 61.1-7)
��_
surrounds Nat strucWre is used to produce income, dewibe Ne use antl portlon
'�:���`��"�"� —'�.."�-�'G��}, ,�{"' ;�,r�`45TANDARD,'DEDUCTION�nuowiwce�i�:„t .�:p,�;��.�^���;�::�.�;i��x
20_Pay20_
Lesser of 1l2 Homestead 5
VauaUOn or 535.000
Sgnature o(AUditw ' Date signed