HomeMy WebLinkAboutHomestead_McEllhiney (4) STATE FORM 53569(Rl/810) TREASLT}R FORM TS-IA
APPROVED BY Si&TE RCM RD OF ACCOUNTS,2909 PRESCRIBID BY T11E DEPARTME\T OF LOCAL GOVESNMENT FINANCE IC 6t.1-na.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
• 101 N. Main Street Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
• Princeton. I N 47670. 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 homestead standard deduction to verify that they are eligible to receive the
��''yq 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 Deparnnent of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
^ 9r1 PART 1: PROPERTY INFORMATION
MAY-11 2011 • Taxpayer Name c:Location Address
C McEllhiney, Tyler Wayne/Kaiie-M
DZVbtCED 5716E 1755
GIBSON COUNTY MID TOR FRANCISCO IN 47649
4493 - - —
Tyler W McEllhiney IC III Dllll�lll�llllll�l I �IIIII�IIwII 1111011IIIIl�hIllIIIIICI [ lIC111111
_
5716E 175 S - _____ " —
FRANCISCO IN 47649-9030
•
IIIIIII'll'lli'lillI'1'I'illll'111'llliilttllllllrilrlrlt6llllll State Parcel Number / Legal Description
26-13-19-100-001.524-004 /PT NW 19 2 9 .514 ac
5
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
r'\ o:JA\PAYER INFORMATION ,
_ -- — PART= — — —
0 First Middle Last
-T- VLrk WA `IWE .. h(.c.-FLLN1Al L---y
Mailing Address(number and street,city,state,and ZIP code) ® Same as property address
57I(o E 1755 FRRNLISco, :TA) 47611
_,
Spouse First Middle - _ Last -
Mailing Address(Number and street,city,state,and ZIP code) • El Same as property address
•
SoyiaL$ecurity Number(last 5 digits) , Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
^—f t I I I 1 I - I Stu
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 Date
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
s CREDIT /STANDARD DEDUCTION HC10
j State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instmclions.
I (We) ertify, that on the 1st day of March, 20
I.((We) occupied as o dnclpal place of residence the following describe I property for which a Home Lead Property Tax Credit is hereby claimed:
�1 I (We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACT. RECORDED':'`
If buying on contract, Fee Simple owners name
Recorders ofics where contract is recorded Record number Page
ROP. ERT, YAESCRIP. TION� 'L.,.,r.�_,m�.`'n*`'E.w`,'��rN
County
Tamship
Taring Irict (cif town, township)
Parcel n�u^lmber
^^
Leg description Is the property in question:
d �-
1;- - Si eal property ❑ Mobile Homo (I.C. 61.1 -7)
H any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that str ucture is used b produce income, describe the use and portion
of the property uGl'i7 d to produce income.
c-�G -/03 -/ 9-
'"' � 4 r
= AS5ESSORUSE ONLY `?
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Sig ture of an ,
Address (number and street, city, state, ZIP code)
Box 7-3e
'"' � 4 r
= AS5ESSORUSE ONLY `?
�RUETAXr��
f""'
ASSESSED VALUE
��++ HOMESTEADy
'`' NON- RESIDENTIAL'f
i . `'
£_.fi�s�:.,s7dr
.aVALUE
-
_ ATx700 %,OFTTV
µ'r;VALUEsa;,�
Land not exceeding 1 (one) acre immediately
fixf ,Y+'t'�x"•g*4r`+'.rry ";'e'"�Ifi
surrounding residential improvements.
(1)cLt
.iss'
Other land
(2)
kt 'TaW-A
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential Improvements or Annually
Assessed Mobile I Manufactured Home
Gam g e
(5)
er
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(g)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 1r2 Homestead
valuation or L35.000
Signature of Auditor Date signed I
a� , v- .., Q 1 � .- 'k - C-\ i I J