Homestead_Teeters STATE FORM 53569(R3I5-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1--222-8.1
- IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS w�•
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
iieduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
auses 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 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.
r.11: PA' I: P'OPER YINFORMA . ION . - .4.:!-: -,- ; : ;
Taapaver Name Property Address State Parcel Number Lee)DescriDlion:
Josh E Teeters 7587 E 350 S 26-13-33-100-001.536-004 PT W NW 33 2 9 2 AC
FRANCISCO IN 47649
.Complete and return to: iIIIiiffilIOIIiiIi61HEI1i0f1IIBL RIWIf lima i 1117f'.IIiIt
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
s
Owner 1 I First Middle last
OSAN4 it"'c is.r it0f5
Mating A cress(number arc street city,state and ZIP dude) I �ame as property address
Middle Last
Y )01IL Ann irc -eirS
Mailing Address(numbs.and street,city,state and ZIP code) Same as property address
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
at, `4_.-... • - -' ,z'PAR.T 4:ADDITIONAL dNFORMATION
rTT rn
1. 14 IL .L./ U,Li
NOV 2 2012
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION HC10
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS., See reverse side for riling Instructions. -
I (We) I I I sw� 1-1 %�j p Q KQA A certify that on the 1st day of March, 20_
I a) occupied as our principal place of read a the following described real property for which a Homestead Property Tax Credit Is hereby claimed:
4
Fl (We) owned ❑ Are buying under contract
aave 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 -',f ,4j r
If buying on orintract, Fee Simple owner's name
Recorders offloa where contract is recorded Record umber Page
PROPERT*DESCRIPTIOW'.'-
County
Tovnship
Taxing
(city IQ*%-township)
QXJ
Parcel number
Signature of claimant
tio
is the property in question:
I
hola -(3153L-(n
Land not exceedin .g 1 (one) acre immediately
Signature of V
eel prope
42t! property ❑Mobile Home (LC. 6.1.1-7)
If an portion of the residential structure or the land not exceedi e (1) am that a
y immediately su wnds tharStrucbire is jl�%Pd to produce income, describe the use and portion
of the property utilized to produce income. ��7-
cyr� -1,3 -J /0 - 00/ .1--36 - 06
4ORbOtkTY'dWNE6'6y:cLAIMANTIWOTkEk"t-OUNTIES���Rys��
County
Township
County
Tovnship
I hereby certify the above statements are true, correct and complete.
Signature of claimant
as
W(number and steel, city, state, ZIP code)
STANDARD, DEDUCTIOWALLOWANCE
i�-,,TRLJE'TAXj —
ASSESSED VALUE
HOMESTEAD ?, '
-'T- 3 `NON
--RE
Lesser of 1/2 Homestead
QE4 �Wi
'
; -
KAT00%-0fjT1V-
-'---
VALUE'
�Wj.' ,VALUE ,
Land not exceedin .g 1 (one) acre immediately
Signature of V
Date Igned qzk
surrounding residential Improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residenti al Improvements or Annually
iZ
Garage
(5)
Assessed Mobile I Manufactured Home
(Pl ai improvements
(6)
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 pits line 7)
(8)
I hereby certify the above is true, correct. and
Signature of Assessor
Date signed
complete.
verifying action - Signature of Auditor
Date signed
STANDARD, DEDUCTIOWALLOWANCE
20 _ Pay 20
Lesser of 1/2 Homestead
Valuation or $35,000
S
Signature of V
Date Igned qzk