Homestead_Hill (14) STATE FORM 53569(RLS-09) TREASURER FORM TS-I AI
APPROVED BY STf:E BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1-22-8.1
' 0 ' AN Gf0fflJ 'UU at I AD " OP '' YOWN •'•S. - . .
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
'Pauses higher tax bills for all; therefore, HEA 1344-2099 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 '. lc 'RO .R YIN ORM 10
Taspver Name Property Address State Parcel Number Leal Description:
T J Hill 315 S Seminary 26-12-07-401-001.475-025 019-01475-00 PT SE 7-2-10.15 AC
Princeton IN 47670
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
_ . . &4 INFORM A1Jf1 - ` •
Owner 1 Ftrst Middle Last
• J ' f—(; I I
Mang Address(number and street.rny.state and ZIP=de)
Jl Same as pc Livery address
15 S . SQ,,,.1., ,c ��1 . ��,,2,4o, )) T
Spouse First Middle Last
Madag Address(number and street,dy,state and ZIP code) I V me as property address
Sacral Security Number(last 5 digits) Dieters Licersa State ID Number(last 5 digits) Stele Other(please speedy lo Part 4 below) •.
L .GER' IFICA ION.' , ---
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 S ^^ Date 5/7 / 10
( )
t8ADDITIONALINFORMATION ,
•
•
°' CLAIM FOR HOMESTEAD PROPERTY TAX
t CREDIT/STANDARD DEDUCTION
S1ate Fortn 5473 (R8/7-07)
� u` Prexnbed by Ure DepartmeM oF Local Govemment Finance
WSTRUCTIONS: See raverse side /or filing insWc6ons.
�"� F C' , �� t��i
R �:
� ��'
I�� I�J GI�SON�OUNTY AUDIrc7H
I(We) �. L certify at on e 1 st day of March, 20_
I(We) occupied as our prindpal place of residence tlie (olbwing desuibed real property for which a Homestead Property Tmc Credit is hereby daimed:
1 I(We) owned ❑ Are buying under contrad
� Have a benefidal interest in Ne entity that is IiaWe for the property faxes on tlie property and that owns the property or is buying under a contrad.
If buying on wntraq, Fee Simple ownera rmme
wrrtraa is recarc)ed
Cou�ry
Twmship
town,
Recwdnumber IPaga
Pamsl number L/e�/ al descnplion � Is Ihe property in queslion:
! T S� 7�.Z .' ( � _ � S 14 �— ❑ Real PmPertY ❑ Mobile Fbme (IC 6-1.7-71
If eny portion of ihe residerNal sWClura w Ihe land not ezceeding one (1) acre Ihal imm�atey surtounds 11�a1 sUUCWre is used b produce Inmrtre, describe Ihe use and portion
d Ihe property utiGzetl In pioduce incwne.
�(o-i�.-o�-40l-00/. ��-S-o�b�
Toxnship
Coun�y
I hereby certify Ue abwe shatements are We, correct and complete.
(nurtrber and sVes4 ciy, sfete. end LP cotle)
Land not exceedifg 1(oire) acre immediatey
surrounding residential improvements.
Other land
Tdal land (line 1 plus line 2)
Readential improvements w Mnually �����9
Assessad Motdle / ManufaGUred Home
Garage
Other improvements
Tctal improvements (line 4 through Gne 6)
TUaI value (line 3 p!'s lirre �
I hereby certify the above is true, corred, and
complele.
va�ryirg acii«i - Spremre of nudim.
ZO _ pay 20 _
Lesser of 12
Homeslead Valuation
a
45,000 for 2007 pay 2�8
44,000 for 2008 pay 2009
43,000 for 2009 pay 2010
(�)
(2)
(3)
(4)
(5)
(6)
��)
(B)
42,000 for 2010 pay 2011
41.000 for 2011 pay 2012
40,000 payable aRer 2012
S
Twvnship
-- =��?:' � ,
signed (manfh, tlay.Yee�
signed (monfh. QaY. Yea/)
signed (monfh. daY.Y�