Homestead_Whitmore STATE FORM 53569(R3/5-10) TREASURER FORM TAW
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-32-5.I
,` IM ':O ' AN; 1_1(:)IILO jhlajj x/V 17 ' ' 0 ' a'4 Y OW
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
40: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 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.
PA'TI: PROPER. V INFORMA, !ION
Tama.er Name Property Address State Parcel Number Leeal Description:
Debbie Whitmore - 11609 S ISO E 26-23-09-300-000.771-024 PT W SW&PT NE SW 9 4 10 1.95
HAUBSTADT IN 47639 AC D-9
Complete and return to: 11Th11I1111I1I1111MOUM01111111I111I11IIIIIIIIIIIII]IIIBH
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
Owner I First Middle Last
//
Mailing Address(number and street.oty,state and ZIP code)
Same as property address
Spouse First Middle Last
0/OF
Mailing Address(number and street,city,state and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number(last 5 digits) State Other(Please specify in Part 4 below)
= a 1;AyQ`r•e�z PARTf3tTCERTIFICATION.,. . •`'' - „
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and a 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 ignature Date
PARTA4!"ADDITIONAL INFORMATION '
•
•
� CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
♦ � State Form Sa73 (R6 / 403)
Prescnbed �y t�e Department of Local Govemmenl Financ_
INSTRUCTIONS: See �evcrsc side !or lilinq insbuclions.
FORM YEAR
HC10
i�we� A'� / U�/ �/ l U/0 r�� CX. certify Ihat on the 1 st day of March, 20
r�-- .
I(VJe) occupied as our pnnGpal place of residence the following described real property (or which a Homestead Property T�c Credit is hereby daimed:
❑ I(VJe) owned ❑ Are buying under wntracl
� Have a benefidal interesl in the entlty Nat is liable for the property taxes on Ihe property and lhat owns ihe property or is buying under a conlraU.
If buying on coniraa. Fee Simple owners name
Recordefs olfice where coNraq is rewrded
County
Tavnship
Record number Page
ESCRI?TION �.,-:. . -^- . - • - .. -.-. -`
Taing tlislritt (Ciry, tawn, township)
DD? 7J ,v v I L '�js n�,{�/�d1� ��L ��' �e Property in queslion
❑ Real pro0erry ❑ Mob'le Ho Q C 67 1-7)
ol Ue resiCential sWCtura or the nd not exceeding one (1 � acre Nat immeEiatey sunounds that swUUre is uud to produce income, describe the use and Dortion
y utilized to produce inwme.
Q-�-ID ��q� � �
-000. ��i oa�
�.�a�-r. �4'na� ,:a • - - �rFROFERTY�OWNED��BYCLAIMANT�IN.OTHER'COUNTIES� � -�'�?�;:s�";'�-,-
County Tawnship Couniy To.vnship
I hereby certi(y the above statements are true, correct and complete. Signamre ot claimant
Addr s(n m r nd tr (, city, sfate, ZI e .
�� ��� �1"' ASSESSOR�USEON�Y �,. : TRUE�TAX ASSESSED VALUE --HOMESTEAD�' NON-RESIDENTIA� . � �
^"-:�i�'°e;.Y.::...:.:f..,... z.=�.•-�-- _ . VALUE - AT100%OF�.TN 'VALUE; r- �,.�'::::VAI.UEt���
Land not exceeding 1(one) acre immediatety x- -K - -..
surrounding residential improvements (�% . .. � - } �
O�her land (2) - � . �
To[al lend (line 7 plus line 2) (g�
Dwelling (4) . s ..- '
Residenliel improvemants or Mnually ' '
Assessed Mobile / ManufacNred Hane Garage (5� .�E"� _. • . .
.r->.;..�'•. . '��.>?.�.. .:
Olher improvements (6)
TUaI improvements Qine 4 through line 6) (7� .
T[fal value (line 3 phs line n (g� �AN 1 g 200
I hereby certi(y the above is lrue, wrrect, and Signawre otnssesmr � Date signed
complete.
Vrlitying action - Signature of fwditor A s ned
G�gSON
COUNTY re
Signature
20 _ Pay 20 _
Lesser of 1/2 Homes;ead
va�uauon or 535.000
= -�5TlWDARD.DEOIICTION
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