Homestead_CarrolliTA7'E iOR.\I 53569 (R3/&10) iRF.A$URER FORM TS�IA
MPAOVED BY SiATE BOARD OF ACCOU�TS.:OW PRESCRIBFD BY THE DEPARII�M OF LOCAL GO\'F.R.\:NE\T Fl\�,uCE IC61.6?'.8.1
, � � / / / . ' I � , I � , � ..'-"Q?f�.•.`.o
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
.•i�duction 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 homestcad
standard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
informatioo necessary to allow county government to better monitor homestead filings. This information
�r�ill 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. /
Taxnaver Same
Da��id D Cartoll
Comp(ete auJ rettrrn (o:
Pronem' Addrns
591 W350S
PRINCETON W 47670
State Puod �umber
26- I 1-36-200-001.757-027
Le=al Dncrinlion:
PT �E 36-2-1 I 1.02 AC
D-17
IW1�IDlIJ ���ll���I���
GIBSON COUNTY AUDITOR, 101 N A7AIN PRINCETON IN d7670
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�q,� W 357� S
Sotial $eaairy Numbar (last 5 digiu)
`
as yoparty aoareu
9rte
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MiGCie
mmiuu
Ourer (dease spedty in Part d baloal
LaU
�i'ro � �
as property etlCreu
sne � Otnar (deasa specitY in Part d Oe1ow)
tach undersignetl certrtles, untler penalty of peryury, that the above antl toregoing intortnation is true antl CArrea ana that he or she is eligible to reteive t
homestead standard deduciion on this property. Each undersigned also understands that, by claiming additional homestead deductions unlawfully, he or
she may be 1ia61e for back taxes and substantial financial penalties.
CR^n
Date
--/ Z-
Spovsa SianaNa - � Oate' -
sl� la -� �- � �-
GIBSON
re�eywn.
(
ClJUM FOR HOMESTEAD PROPERTY TAX
CREDIT/STMIDARD DEDUCTION
s� rw� s�rs �� i sa�
Plesubed by Ihe Depatrriart of Laal Govertvnerd Fsianoe
INSTRUCTIONS: See reverse side !or filing ins6uctions.
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_':�.. ..> . .. • ,. �• : . � c :. •� .• •• ,;, ,.. CERTIPICA710N STAlE11E?R�`.; f ^-.� - - ' .. .:- ���"t' + z:i;li.'••'t,+
� . 1..,.., . , �... .. .. . . . ,. ..�_. ... . .... , ..< , _., -,. ... . . : . '__..� .� ._ . _,
� (V�e) ��SLD� N � . . ^ . . C �`-'L, cerhivQh`dK&ftitf�"TsZ�dBv of March 20
I(We) ocapied as ac pr"vidpel place M ' er�ce the foBowirg desa3ed rral poperty tar which a Homeste��l3{%$eby daimed:
�'�)�� ❑ � Glti
buymg under oontrad
Have a benefidal interest m Ihe entiry that is liable for Me popeAy �ces m IAe propaly and Cat owns fhe properly w is buyug under a con6acl
�
tt buyug m mntrac4 Fee Sirt�le owiefa mrre .,
fLamrAefs alfioa rrhare mMati is recorded
Canb TuH6tup.
T�g
I Recud number I Pege
..-. r?rr... •.J i H �.Ti'rY c F i..
Pa�mi nmma � Legal b Ihe poperty n quation:
°°�vE 3� -a - �i ❑ �,�, ❑ �b �,�.�. �,.,_�,
�n w�� m u,a resde�kial crumue a me Im�d na �ng Wa,e (1) eae mal'rnmadulely a,na,� maa am,m,e ia usea m prad�oe mm�,e. dasa,te nie �ae m,a pu6a�
poperty �imtl Oo p�oAre'vimna.
a�-��-3�-aoo-oo,. �5�.�0��
2 ..`• � ... ` .. � .. • �y� . �.Tr T%JE TAX r .r� ASSESSm VALUE -'HOiffSTEAD; � '` �� NON�iESmBlilALtf� �`�
r ��:, <^ /LSSESSORUSEONLY. • � {�'�l� VN�tF�',, �•AT100XOFTTV � . VALUE ��..,��°��S.al.^mVALUE �it.`-'z�'4;fi
Sn .x i- L fnd.. ..+-�.-
Land rot e�ng 7(one) aae irmiedialely �; ����� ,� . n�J� d��+� /a`�.�`'�s3 1
�9 ��� ��� 5u�°ti} a 1, " .�' �S'{�'`�' �4S
siarrna'd' residenfial i ts. � �� T
.k.�N Y ,�dvv��aV EiR.
1 f l .
�18f �2fld � ^�- J � S ���i�.
�2� !n `?'{vY,,Yt�i:
Tdal land (I'are 1 pku fire � �3)
�4' �ti.`y�i*'�`� ii a' fi r� �+'� ',�]`i
ResdenEal vnprvvMn2nt5 QMrwwally ��� �4� �,� � ;,,'.�'�w��^ egF `F•��e„� �`�'�.•�-u"�""�,�t,��
0.ss�ed MoWe I� Fiome ' Yk,t� �,� ,£ ...�C� Y��F.r���y-;.
��e �5) �....t4?o Ss .,.A!.. h 1µ a�`�:3. 1F.'?�,`✓�f'i�
! � 1�.
�}18f QfIQfOVElf1Ef��S' �s� � `. � s
av: . ti
Tdal cnprovemer� (fine 4 tivou�h 6ne 6) (7)
Tctal value (I'nie 3 pha ffne n �g)
I hereby cer6Ty ihe above is true. mie�2, and S9^�ea of Assessa Date eip�ed
�nplele.
vailyirg amon - Sipreme of Pudrtnr Date sipned
. . . :;STANDARDDEDUCTIOtIfLLLOWAXCEr =.�'sM �a4;".`e" .>..x���;=�.�`�.�:�s
20 _ Pay 2b _
Lesser of 12 Hotrest�d
Vduation or 535.000 S
si(�,�aa or n„Ntu ' oaf° sp'°d