Homestead_Miller '
SIAM FOiSt V!4 tier-0.1 1REAStUER FORM TS-IA
AM?M ttsaY<MSIE BOARDOF Army:.NIS.:w. PUS-TUBED BY 111E BEIARTh MT OF LOCAL GOVERNMENT MP:A`iCE IC 4-I.I-224.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individual and married couples are limited to one homestead standanl deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than e'er for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
0 HEA 1344-7009 requires taxpayer who receive the homestead standard deduction to verify that they are eligible to revere the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.Ibis information will he 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.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Miller, Ernest Van
RI Box 275 A
Francisco IN 47649
1834
Ernest Van Miller
6859E 250 S State Parcel Number Legal Description
FRANCISCO IN 47649-9057
1t1n11tu1r11nt1n11l�ultluliunitltlnllt�lltltlntltlL� 26-13-29-100-000.792-004 002-00792-00 PT NE NW 2929 1AC
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.
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
alp g Address(number and set,city,state,and ZIP code) - — — I�1 Same as property address - - -
O
0959 E. ,)SO S htte t , .7- 34 6(9
Spouse First Middle Last
Mailing Address(Number and street,thy,state.and"LIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
roe
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
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R21592) .
INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEM ENT
1 (We) _&1_rLLa y t_ DL _ V —�% (M�, certiy that on the 1st day of March, 19_
a e) occupied as our principal place of residence the fol U ing described real property for which a Homesteqty TCr00j5bBcQby claimed:
L_f I (We) owned El Are buying under contract _ - - -u, I OR O '
❑ 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 owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township) -
Parcel number
Legal description L
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
- xg -
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
I reby certify the above statements are true, correct and complete.
Signature of claimant
�'
o
Address (number and street, city, state, ZIP code)
O
r
ASSESSOR USE ONLY
TRUE TAX
VALUE '
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
Signature of Auditor
Otherland
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pits line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 112 Homestead
S
Valuation or $2,000
Signature of Auditor
Dat gne