Homestead_Halbig (5) STATE FORM 53569(8316-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,222009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.122-8.1
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Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
a°duction becomes 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 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.
- - PA a TI: PROPER Y INFO• At ' a N
Taxpayer Name Property Address State Parcel Number Lent Description:
Keith L Halbig 703 N PRINCE ST
PRINCETON IN 47670 26-12-07-102-002.279-028 OLD PLAN 143 PT
Complete and return to: IIII]II11[11111I[1.I[IIllhtll!I[1111111111 01111lhIII.1111I[I[IIJII]IIII
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
• • frY:YCFgigT• P• •R O: u : ION . ••
Chimer t First Middle Last
Mailing dr s(number and street,city,state and ZIP code)
Same as property address
Spouse First Middle Last
Mailing Address(number and street,aty,state and ZIP code) Same as innerly address
Social Seamy Number(last 5 digits) Drivels License/State ID Number(last 5 digits) Stale Other(please specify in Pan 4 below)
et PAR &361F:14, IIFIGA. ION 4.,,,=
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 liab- or back taxes and substantial financial penalties.
Owner .nature Date
'" - •.',,,' ,
•
�l���`��"" - CLAIM FOR HOMESTEAD PROPERTY TAX
�_ j CREDIT/STANDARD DEDUCTION
�i State Fortn 5473 (R2 / 592)
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INSTRUCTIONS: See reverse side /or liling instructions.
FORM
HC10
YEAR
'��, CER FI ATIO ST TEMENT _
I(VJe) certfryit�on�the lsfda`y ofMarch, 19_
1(We) occupied as our principal place of residence the foli ng descnbed real property fo hich a Homestead Piopertyy � C`retlit is�`�,he(eby daimed:
❑ I (We) owned ❑ Are buying under contract �' � � � �
IddV 'i (� 4�C�:}
❑ Have a beneficial interesi in the entity that is liable for Ihe property taxes on Ihe property and Ihat owns [he prOperly or is�.buyipplunder a contract.
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CONTRACTRECORDED ! f Lf} �l f -
If buying on convacl, Fee Simple owners name - � L;�.���e �'�_1�'%��-� -
� GIBSGt! G :'U�.?'! �+ �::Cr. .
Recortlefs office where conVact is recorded Record number . Page
PHOPERTY DESCRIPTION
Counry TownsNp Tamg district (city, wn,
Patce�� r ��� � Legal description ��
U
It any portion ot the resitlential structure or Ihe IarM not eaceeding one (1) acre thai immediatey surrounds thai structure is usetl to D��uce inoome, describe the use and portion of
the properry utllized to praduce incrome.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County Township County Township
� n ' f laim nt
.ereby certify the above statements are true, correct and complete.
A r number and street, ci , siate, Z e) • � �^� ��
/
� ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land noi ezceeding 1(one) acre immediately �� �
surtounding residential improvements. �
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Oiher 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 Signamre ot assemr Da�e signed.
wmplete.
Verilying action - Signature of Auditor Date signed
.�� STANDARD DEDUCTION ALIOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead y
aluation or 52.000
Sig re of Audito Date signed
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