Homestead_Wallis (2) STATE FORM 5J569LR)/5-10) TREASURER FORM TS-IA
APPROS:D BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1 '-S.I
IMPORTANT NP ICE TO AOMESTEAD2PROP,ERTY OWNERSr . 416
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
''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.
si 65+ +,ii' i3 d-.tar ;PART It4PROPERT.Y4INFORMATION' „ -
Taxpayer Name pronem.Address State Parcel Number Lezal Description:
Clifford E/Tracy A Hill Jr. 113 VERMONT ST 26-12-18-304-003.564-028 BROADLEIGH PARK 53 P1754
PRINCETON IN 47670
Complete and return to: �DIll�UDllIlllDlll01lQ110111 JIIUUfIIOVEI I[llll'1[11 (3Illl
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
W-311,4t.` x .. ? `: `' . •.!;PART 2c'.TAXPAYE12 INEORMATIONtF�i'�+b�` 5r1. n A7-iir -�`•r kA
Owner t1 First ��Q �/� p Middle 1 q) 1, q ' t� last
Mailing Address rands city, and ZIP 1 \� as property tltlress Swt ame Ora- ^
First Middle Last
Oa Lv,.o1arre. LV
Mailing Address(number and street,dry,state and ZIP aide)
Same as property address
SBsS Resecr-v-, `D\ S t3& S C 1 cm '% \ 58
.''�^ ma, ?0:77>ae,
f C
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
•
•
r
ILED
DEC 27 ;"311
GIBSON COUNTY AUDITOF
�f R�R
E °, CLAIM FOR HOMESTEAD PROPERTY TAX
i,���: CREDIT/STANDARD DEDUCTION
:.�.;� � State Form Sa73 (R2 / 5-92)
�u�
WSTRUCTIONS: See reve�se side lor liling instructions.
FORM
HC10
�LI�
'�We��ZC/` �.��X_�,! ��/ _�.l lC.��� certify that on ihe 7 st day of March, 79 ''
�, occupie as our principaLc:a�of residen the following describ real property for which a Homesiead Property Tax Credit is hereby claimed:
V i �We) owned ❑ Are buying under coniract
❑ Have a beneticial inierest in the entiry that is liable for the property taxes on the pmpeny and that owns ihe property ��in�und� aYroqtra�t.
� � CONTRACTRECORDED � �
If buying on contract, Fee Simple owner's name �
Recortler's ottice where contract is recorded Re ✓ Pa e,
AUDITO �''�
County
Township
Leqaldescnption
If any portion of the resitlential simcmre or the land not exceeding one (7) acre that immediatey surmunds that strucmre is usetl ro
ot Ne property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
�aby certify the above statements are vue, correci and complete.
Address (numberandsrreeL ciry, state, ZlPCOde) _ �
. ASSESSOR USE ONLY
Land not exceeding 1(one) acre immediately
surrounding residential improvements.
Otherland
Total land (line 7 p/us line �
Dwelling
Residential improvemenis
Garage
Other improvements
Total improvemenis (line 4 fhrough lina �
Total value (line 3 p�s line �
I hereby certify the above is irue. correci, and
complete. �
Veritying aCtion - Signature of Auditor
19_Pay19_
Lesser of V2 Homestead
valuation or 52.000
TRUE TAl(
VALUE
l�)
12)
(3)
(4)
(5)
(6)
(�)
l8)
SignaNre of Assessor
�
claimant
ASSESSED I HOMESTEAD
VALUE VALUE
describe ihe use and portian
NON-RESIDENTIAL
VALUE
i
Dare signetl
Date signed
Signature o� Autlitor �A �� I�{, \\ � `�� I �a�e sgrieo '
A I�1 • �_r �i� 5