Homestead_CouchSfATE FOAA151569 (R1/8-10)
TREASURER FORM TS-IA
APPRO\'FD BY SfATE BO,UtD OF ACC011�75. 5009 PRFSCRIBFD BY i}IE DEPART¢�T OF LOCAL GO�'ER.\'�\T FI\A.\CE iCbi.l _+d.l
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
�'°duction becomes more beneficial, there is more iucentive thau ever for homestead fraud. Homestead fraud
•causes 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 governmeut to better monitor homestead filings. This information
�vill 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.
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Tannaver \ame Pronem� Addme Starc Parcel \umber Leeal Descrimion:
\1ark A Couch 9�5 S DEER HAVHN DR 26-12-IS-100-002.066-027 PT NR' IS 2 10 2.047 AC
PRINCEI'ON M 47670 C_�
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GIBSON COUNTY AUDITOR, 101 N MAIN PRIA`CETON IN 47670
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MaWrp AtlOroas (numDSr mtl meet, ary, stata en0 ZIP wCe) � '
I y � Same az prOperty aCEreu
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Sotial
Spausa FiRi Mitltlb Las�
MaYCp Ftltrass (mm0ar arN stree� tlry, zute antl ZIP mEe) ❑$gmB d5 �fOp¢!ly 8Ebe35
$oaal $amiry Nwnpar (lut 5 tllgib) Drivare Licrosel5tate ID NiaMer (last 5 Elpib) �° �� Ideasa spec�Ty in Pan a �eiow�
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Each undersigned certifies, under penalry of peryury, that the above and foregoing information is true and correcl and thai he or she is eligib�e to receive the
homestead standard deduCion on this property. Each undersigned also understands that, by claiming additional homestead deduaions uniawfully, he or
she may be liabte for back taxes and substantial financial penalties.
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GIBSON COUNTY AUDITOR
�; CLAIM FOR HOMESTEAD PROPERTY iAX
' CREDIT/STANDARD DEDUCTION
J State Fwm 5473 (R6 / 1-03)
PreSCribed Dy the DepartmeN of Local Govemment Finance
INSTRUCTIONS: See revcisc side !or liling inslrucfions.
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FORM
HC10
YEAR
l� o JUL � � 'LUU4
�(We) �'%i L„{` certify lhat on the 1 st day of March, 20
I(We upied as our principal place o( residence Ihe following described real property (or which a Homest^ead Property�Tac Credit is hereby.�daimed:
l y
l(�' I(VJe) owned ❑ Are buying under contract J-<� �-�-.�-t�
' Have a benefidal interest in ihe en6 that is liable for the ro e taxes on the ro e and that owns t�f'i��i�is�bu o�undei a wntrad.
�Y P P rtY P P rtY P P rtY Y� 9
If buying on conVaC, Fee Simple ownefs name
Remrdefs oftica where conVad is recorded
County
Parcel number
( L�LC� �_
H eny portion of
at the property i
Tnmship
IRecord num�er I Page
ION��+�r'a crJ.—�y-� R iy2. �-�==,•eYr �� -a7-'%'��?t�n"t%ha
<r'stV+ �'�`_�s
� (tity, tawn, townshiP)
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Is ihe pmperty in QueSGon:
[�}�al propery ❑ Mobile Homo (I.C. 67.1-i
Ne land not exceeding ona (7 � aae that immediatey surrounds ihat suuuure is used b produce incrone, describe Ne use and portion
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rr�.�,;3p,�'ti'?,�'��.' �'�,�,����.,�STANDARD:DE�UCTIONALLOWANCE�,;,rH,-p;,+�,,.�i,�i��,ws-`�.,,s��_'�'�x'��`�`�,�'
20� Pay 20 fp
Lesser of tY2 Homestead S
vauanon w 535.OW
SgnatureofAUddw ' Datesigned