Homestead_Persohn SI■2E IrMY`!!M IR'/Hnl ntrAsurrx TORM TTS_IA
VPIttwEn BYSrs1rwS DMMrrt,Ti2nw PEEYAIBmBY TIE DEPARTMENTOr ux:L COVER:Np'TrPANCE MH.1r-ru
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 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.
® FIFA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recebe the
benefit and to pnwidc additional identifying information necessary to allow county government to better monitor homestead
filings.This information will be kept ennlidential and can only be arce>sed by authorized county officials.The Depanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Persohn, Roger L
733 W CONWELL DR
IIAUI3STADT IN 47639
7229
Roger L Persohn
733 W Conwell Dr State Parcel Number Legal Description
HAUBSTADT IN 47639-8800
26-18-36-200-002.252-024 WATER TOWER PLACE 12 0-27
IIlI lllrrrlriltt rtilririrr lrr lrlrrltilrrr ll Ilr rrilrilir rl
x
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
RDC,6� L6Cg7UD P6Rsot4-n)
0 ag Address(number and street,city,state,and ZIP code) -—.—- - — _ - -_ _ r-'Same as property addles;— —-."—- —___- _ _
_
-
Spouse First Middle Last
Mailing Address(Number and street,city,sate,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number past 5 digits) Other(please specify in Part 4 below)
Scut
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 n Date
•
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
StsM Fortn 5173 (R614-03)
Prnatbed Ey the Departrnerit d loral Gmromment Finaxe
FORM �" YEAR
� ct
iNSrnucnoNS: sea ro�s ataa a�:�m„mm.
,� FEB 2 8 �Ag�-
�_ �Y` r,c P,..r _ - ...�... � 'r".. ' �sz��"�CERT7FICA710N STAiEMENT:. ._ x�'.""�Y-';r-a^.'`.`?:_s.�.�"`3't.: ��u'!i'.'-�5.�"._ "''--'i=�:'
--:a1 - ..f'��., �t�''..�i'`"�:��� -v:iS�.'+�s.._
� M�e) certiry tlfaf/�e� of March. 20
1(We) occupied ur principal place of residence the foilowing described real property for which a Home��dg�{�e��¢�j�TOR by daimed:
i� I(We) owned ❑ Are buying under contrect ��
' Have a benefidal interest in the entity Nat is liable for the property taxes on the property and ihat owns the property or is buying under a wntraU.
If buying on conirad, Fee Simple owners name
Remrders ofice where conVaq is recorded
������.�-i�Xit���s'�-�ti.%���3 �`rS`Y�
CounTy� � Tamship
I( enY GoAion c
af the proDerry
lawn,
Is the
Record number � Page
l��SJ ���� �L �N(LCX l"�� ���I yQ R� 7�oDeM ❑ MobUe Homo (/.C. 61.7-7)
sWCWre ar the land not exceetling one (1) acre that immediatety wrmunds that came is used to produce incane, describe Na use antl portlon
ice income.
���'��.�. _ �;�-�i'.�:,�3����;STANtiARqDEDUCTION AL'COWANCE��.'�e��';�e`a�"��''_,-�-�'sy;�.�t�'_.�F,,�.'?'��S`�?, ��
20_Pay20_
Lesser of 1/2 Homestead
wuatan a 535.000
5
Syreture ot Auddw " Date sgned