Homestead_BreitenCU4!!M FOR HOAAESTEAD PROPERTY TAX
CREDfT/STANDARD DEDUCTiON �
Smte Fann 5473 (R7 / 506i � ,
P�es�ad by tlie Departreienl d Laal GoVermnerd Fvianoe \l/
J
INSTRUCTIONS: See raverse side Rv filing insbuctinns.
+
FORM
HC70
L�I
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� M�e) � cerGy that on the 1 s! day of Mardy 20_
I(We) oca�pied as ac pmidpal place o( residerce ihe fo9ovrirg descnbed real poperty fior whirh a Hmiestead Property Tmc Gadl is hereby daimed:
�� I(We) owrtred ❑ Ne buyirg urder oontrad
Have a benefidal moerest in me entity ihat is liade for the property taxes m the propeAy and Mat owns me property or is buyu�g under a cantract
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in .rs'
If huy"�g om m�h"dcl. Fee Sirt�le oMTteis reme
I�mdds ol6ce rMae mriaG is recadatl Rxnd numDer Pege
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Tawrrslip . ..
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I �i�'� � �//�1J //o ��/U �] r�m v�w��r LJ �ab rw� �i.c. ��.i-�
n a�y po�n a the r�e� �uce,e s u,e �o na �eedire ma (� � eue ma+:nn�d� amu,� n,m s usea m woauce ncare. aeaam u,e �a m,e portion
d Ihe papaM1y utif�d b p(o�ce'vimrie.
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_ , .; ` , : . . "., : �oatmr ovn+m sr c�nuiaNr a on�et cou►rrgs �.,. ' ", .. }:i � :�, � , �,u, �-_
County TornsAip County � Towrehip
� ne�eey oertiry me atwe sfa�ts are aue. correa ana c«rpem. �� a aar�n
(nurbs ene a6eet vry: garo. zIP coee)
.. ` ASSESSIX2USE0lILY .� - �*u�ti%°.' TRUETA7Ct r hSSESSEDVALUE ;FWl�STEAD' 1°'�`v��NONtRESIDENTIA�L�r4��
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.!-:: J. ,�.�. , a,...-;: �..�. .:+ai..+.� YALUE;�t. 'AT,100%OFTNy � VALUEc� ^7'tyS"t�-ta9h:VALUE�1`--:.:s� .,.v�
Lend nd exceedrg 1(one) aae imr�ately � ti�lri �� �'�` i"��•i''°"�: �,��
s�arau�d"vg residential itnprovemen�. (� � ."r � S+li,''ni : , �{ � ��ri _'�Ie�"�erv
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Qlherland (p) � - �;f.�,�iy'r�';
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Tdal land (lirre 1 phis 6re � ig)
Dwel6�9 (q) :�`z � �,<� �`�''E'�^��k'�'�'`-3ott'D�"'J
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Resdenfial "ur�vremenfs aMmialy = �..a'�,�,�t,y.,�+',.r:..��.c u.,-s;m.G:��i ;�
AssCSSed MohlC / MarMe�Yed Fbrtie ��9e S �� '�d�i�`��',4'�� M( v`� Y�����'L
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::�?ex�x.l..•y_�,�,rn..a.-dJ.�i NF,r..
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OMefirtlpfovements (6) "� -:'�"`:a::s'�
Tdal'vnprovements (!vre 4 tivout� 6ne 6) (7�
Tdal value (1'v,e 3 pda ffne � �g�
� 118lfbY CBfh(y @IE BbOVB B 6UC. CORCG� ffif� 59�� Of A4�smr Dx18 eljpled
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Waflyug eCim - Signe6e8 oF Audmr Dafe sipned
. � . . . . , �;ST/WDARDDEDUCTIOt!/1LLOYYANCE . :;�` . .�-.� v�,?;'i"��?*?.`�
20 _ Pay 20 _
Lesser af 12 Homestrad
Valuatian or t35.000 E
Sig�ue of PuNtu �� �
,STATEFO�\151569�R'J3�09)
.1PPR0�'ED BY STATE BOARD OF ACCOU\TS, �009
" iREe�Sb'%ERFOR.NTS-IAI
PRESCRIBED BY THE DEPARTME�T OF LOCAL GOYER.\NEpT FL\ANCE IC61J-II�8.1
t / � / , / • , 1 � , 1 � , �
[ndividuals and married couples are limited to one homestead standard deductiou. As the receipt of this
deductiou becomes more beneficial, there is more incentive thau ever for homestead fraud. Homestead fraud
�auses higher tax bills for all; therefore, HEA 1344-2099 requires taspayers who receive the homestead
standard deduction to verify that the}� are eligible to receive the beneGt and to pro��ide additional identifying
information necessary to allow couot�� government to better monitor homestead fili�gs. This iuformation
�vill be kept con5dential and can onh� be accessed by authorized county ofTicials. The Department of Local
Go��ernment Finance �vill use this information to create tools that ��•ill help county officials eliminate
homestead fraud.
.�, �. �
Taxnaser \�me Pronerh' Address Smlt Parttl \umber Leeal DncrioHon:
Fred J Breiten 944 S I50 E 26-12-16-10p-00.1162-027 006-W 262-00 PT SW NW 16 2 10
Princetan ID147670 `� .5; pC D10
Comp(ete m+d return to:
GIBSOY COIJ�'T1' AUDITOR, 101 N DIAI\ PRINCETON IN 47670
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o+me� i F� �.uaae
C"c�;� �e _�. �--yh Yl. � �����-�„ti
MaJing AtlEress (nurtber aiM sNeel ary. 5�2�e anE ZIP wtle) � .�rl� �� az property aOEress
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9�/4� s. So �, i�Zinc �N �� b
Soda� Senmry NumWx (wzt 5 eqlu) omers lice�rse 9a:e iD Nu�rba Ibst s Elelts) sze ptn� �prase speaty in Pan a telo«I
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Saause First MiaEle Last
�� 2c�. �� �j2�I��-
MaiGty AtlEtess (nurtEer anE sTeel dN. �te aM ZIP cotle) r�$artp as poperty a0tl�ess
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� �-� S � � � �. � � �- � � 1J � % (o D
Satlal Secvnb NumCer (last 5 E�Glsl omers ucrose sraie io ramee. si s mai�) s� wra (dease seeah � Pan a oeww�
� � �
Each undersigned certifies, under penalry of perjury, Nat the above and foregoing infortnation is We and cortect and that he or she is eligibte to receive Ne
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 taues and substantlal financial penalties.
�Owner 1 $i ' Date TdM�
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