Homestead_Agnew STATE FORM 53569(R3 S-I0) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.22009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.I 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
higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
sl'Sndard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
IP
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.
PAR 1: PROPERTY INFORMATION _
Taapaver Name Property Address State Parcel Number Legal Description: ///'''---���
Connor/Mary Agnew 626 E BRUMFIELD AVE 26-12-07-204-000.019-028 NS LOT 3 PT R 2 /
PRINCETON IN 47670 v
Complete and return to: I®IIO MEMEM �ImDI®IIDIIDfIlIinIIDIIIFIIIII
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 J W
T•. N Ot% ON n
Owner I First Middle Last
CI
M ailing Address�(nu r ter and street.ddty slate and ZIP cod e) I
rte as property address
it . jGGa -7 ,r•
-� . Last
/lift frAJA/ . 4gArEW
Mailing Address(nunter a city.state and ZIP code) I ✓ ene as property address
S c iat i7D /it/4r ��2iit/ko i, �".�/. 7X 2D
- .. . :._�, 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 1 Signature Date
'Y , -.PART 4: ADDITIONAL INFORMATION i ' . . -
- —FILED
• NOV 19 CUIZ
"SSO' rOI INTY AUDITOR .
r
I
�:�<•�� -� -CLAIM FOR HOMESTEAD PRORERTY TAX
` d�p 4` CREDIT/STANDARD DEDUCTION _.
�..;
:) 7. 7 :
.� State Form 5473 (R2/1-90) '
+•�' '°�° � INSTRUCTIONS: See reverse side lor filing instructions.
.
CERTIFICATION STATEMENT
_ FORM
HC10
V
_ YEAR
�
I(We) ��� _ + certify that on the 1 st day of March , 19 ��
,I (We) occupied as our principal pl�ce of re idence �the lowing described real property forwhich a Homestead
Property Tax Credit is hereby claimed: hCJ I(We) owned ❑ Are buying under contract
Have a beneficial interest in the' entity that is liable fo� the property taxes on the property and that owns the
�` property or is buying it under a contract: �
_�� ��a .
�
If buying on contrac�. Fee Simple
Recorder's office where contract fs recorded . '
N�
RECORDED -
RTY DESCRIPTION
Township
Legal Description � � �
Record Number
(City, town; township)
Page
If any portion oi the resideniial structure or the land not exceeding orie ( 7) acre that immediately surrounds that struc-
ture is used to produce income describe the use and portion of ihe property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township . � County�_ Township
�
hereby certify ihe above statements are true.�correct and ' Signature
.,omplete. ' -
Address (Street, number. city. state and ZIP code)
ASSESSOR USE�ONLY �_ TRUE TAX VALUE . ASSESSED VAWE HOMESTEAD VAWE NON-RESIDEN77AL
� � � �` � � VALUE
Land noi exceeding 7'(one) acre immediately ' � �
surrounding residential improvements i� � '
Other land (2) "�
Total land - line (1) plus line (2) (3)
Residential improvements � - �Dwelling (4) -- - � - - - � - - - - �
Garage (5)
Other improvemenis (6)
Total improvements - line (4) [hrough line (6) (7)
Total value - line (3) plus line (7) (8) � �
I hereby certify the above is true. Signature of Assesor Date Signed
correct, and complete
Verifying Action - Signature of Auditor Date Signed
1989 Pay 1990
Lesser of 7/2 Homestead
Valuation or $2,500
STANDARD DEDUCTION ALLOWANCE
1990 Pay 1997
Lesser of 1/2 Homestead
Valuation or $2,000
1991 Pay 1992 19—Pay 79—
Lesser of 1/2 Homestead Lesser of 1/2 Homestead
Valuation or �7,500 Valuation or $1,500
Signature of Auditor Date
(� ,�. ,,,, n . �i CYl �2,�- g -1