Homestead_Hurst (10) STATE FORM 53569(R3R-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1 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
eduction 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.
- PAR I: PROPER. Y INFORMA ION - t';« f.
Taxpayer Name prouem Address State Parcel Number
Ina)Description:
Robert]Hurst 36 S 3AB'FIFTH AVE 26-11-12-101-001.277-028 TOWER HGTS 183 PT
PRINCETON IN 47670
Complete and return to: III @Ilfl 1:119II[Illtitll!l7p Bn II:Bnlllum9{{��+ Ptfptum @@:pine
mu11HIDBCtg EHMa Uliniatl9liiB[I�JIIIM1M NHEItllll
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
• -' PART 2: TAXPAYER INFORMATION • - ,2.4
Owner I First Middle Last
hs5bert .�Avne 4-, LI rsl_
mailing Address(number and`street,city,state and ZIP code) 'nee L V
ZOO • V t city, Prltn ok) . 1< 1 1P17l..Gdr-70
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 ' nature Date
�,.�-:14 '. ' ' ?: PART 4:ADDITIONAL INFORMATION .-
/2
//
7/
iOflM HC 10 1979
RescrihM By Sute BoarE ol Ta� Cammissioners
To Be FileG in DuD����e
CLAIM FOR HOMESTEAD PROPEHTY TAX CREDIT FOR YEAR 19� �
SEE BACK FOR FILING INSTRUCTIONS . O/CJ � D� p'� 7�� Oa
�(We) ��"%�� ��—� ��- �• certify that on the 1st day of
March, 19Z`� I, (We) occupied as o pruv incipal place f residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We�owned
❑ are buying under coritract
❑ have a beneficial i t e�t_ in the taxpayer
Property Description in �
� _
Taxing District (City, Tewn-�ewnshig}�
\�� � Township
Parcel Number or legal description shown on tax statement:
: ,h.�,� � J � � r'u�—
If buying Ofl contract: Owners name ��� y�^de owner�
Contract recorded in Recorders Office - Record No. Paae
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property:
�tiereby certify the above statement is true, correct and complete.
County Township
` Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer. �
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(o�j a�e im�dia� �
surrounding residential ir�prov��nent
Other �and J JV L ��3�g
Total Land
Residential Improvements
� / ing
y',
�/l� AUDITt��a9e
Total
Other Improvements
T�'mprovements - Line (6) plus (7) equals (8) �
I hereb� certify the,above is�t7ue. correct. and complete.
Appro
ASSes50r
%0
True Cash Assessed Homestead
Value Valuation Valuation
. �
� J •
• �� � ���������
� � �..�/��i
/.//�;��",,.%
- '-•' - - _
(�) ° — — � —
(e� l�� ,S-=/—��-
�-o�� -��
�a:e -
�/
Date: