Homestead_Scott STATE FORM 53569(Rig-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1.22.8.1
- IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
s dard deduction to verify that they are eligible to receive the 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 Department of Local
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
PARTI: PROPER Y'INFORMA ION
Tunas er Name Property Address State Parcel Number Leal Description:
Harlan E Scott 3983 G 50 S 26-12-14-100-000.645-004 NE NW 14 2 10 2 AC
FRANCISCO EN 47649 C-1
Complete and return to: I®IIDD]DV[lDDf[1fDEDIm II 1111111 101301111111111111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 11!
PART 2: TAXPAYER INFORMATION ,
Owner I First Middle Last
�/AR N E< ccco77—
Mailing Address(number and street.city,state and ZIP cede) % „
Gene as property address
a First Middle Last
Mailing Address(number and street any,state and ZIP cede) Same as property address
Social Seaaity Number(last 5 digits) Drivers License/State ID Number(last 5 digits) state Other(please specify in Part 4 below)
. 1
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 Si Date
( )
PART 4: ADDITIONAL INFORMATION
FILED
MAY 7 2012
e.J.rr
nIR QM COUNTY AUDITOR
CLAIM FOR HOMESTEAD PROPERTY TAX
i CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5 -92)
16
INSTRUCTIONS: See reverse side for filing instructions.
r\
M YEAR
MAY 0 3 2000
= CERTIFICATION STATEMENT
r
I (We) certify t 'I cnt'63s;1$a)Tdf Maltiml
occupied as our principal lace of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
I,,,,,,AAAAAA(
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PWe) 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 office where contract is recorded
Record number -
Page
- PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township)
Parcel number C'
Legal description
l
—�T' 0 —
If any portion of the residential structure or the land not exceeding one (t ) acre that immediately surrounds that structure is used to produce income, describe the use and portion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
Signat c mant -
ereby certify the above statements are true, correct and complete.
'
Address (number and street, city, state, ZIP code)
�a
2. 8x.a7 e PA Y770
ASSESSOR USE ONLY
TRUETAX
ASSESSED
HOMESTEAD
NON- RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Otherland
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
,
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assesor
Date signed
complete.
verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19 Pay 19
Lesser of 1/2 Homestead
S
Valuation or $2,000
Signature of Auditor
Date signed
S-