Homestead_Koca 'MALE'FORM IIL'/>4NI TRIASURTA FORM TS-IA
.APPROVED BY STMT.MIRO(Y ARV1i\T<.!OW PR/SRrmmBY THE BFFARTMEYT(f LOCAL CAIxttNMrxr FINANCE IC -I.12-!.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N Main l
PRINCETON IN 47670 Individuals and married couples are limited to one homestead sundani deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore.
FIL HEA 1344-200c ye
requires taxpars who receive the homestead standard deduction to verify that they arc eligible to receive the
i s benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
s
/ I filing.This information will he kepi confidential and can only he accessed by authorized county officials.The Department of
Local Government Finance will nse this information to create tools that will help county officials eliminate homestead fraud.
AUG 9IWO PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
te Koca, Edward F/ Kathryn S
�� ✓ 6, 321 [Glendale
GIBSON COUNTY AUDITOR
Princeton IN 47670
2624
Edward F/Kathryn S Koca
321E Glendale State Parcel Number Legal Description
PRINCETON IN 47670-1642
1I1r r11tttlt llt tltt tlll IIt IIh tr Irrit tlt it tlhitttIllitatl 26-12-07-201-000.348-028 01400348-00 WARNOCK 11 PT
PART 2:TAXPAYER INFORMATIQN
Owner I First Middle Last
w a Ka) c �
— ._•hg AJJrsas(numin-r mldstrm :a
t,sir:,statendZlP:ode). _ 0.Same as property address_
Spouse First Middle Last
L
Mailing Address(Number and street,city.state,and ZIP code) El Same as properly address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
sou
PART 3:CERTIFICATION
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
•
� CLAIM FOR HOMESTEAD PROPERTY TAX
'' CREDITISTANDARD DEDUCTION
S��te Form 5473 (R611-03)
Prescnhed by the Department ol local Govemment Finance
WSTRUCTIONS: See revcise side /or �ling insliucfions.
,� o�-��
�^I�a FORM 1'EAR
� 1
�(we) � � certify on the ay o r
I(VJe) occupied as our principal place of residence th f Ilowing descnbed real property (or which a Homestead �p�tr@j�ed
❑ 1(We) owned ❑ Are buying under contract
' Have a benefidal interest in the en6ty that is liable for the pmperty taxes on Ihe property and that mms the property or is buying under a conVaG.
I( byvg on conVaa, Fee Simple owners name
contrad is recOrded
Counry (
as�
P rcel numbe` � l/
I any portion ai Ne residential sV
ot Ihe property utilaed tn produce
Tamship
� �egal tle ptlon �.�/ Is the
w Ihe land not axceedi��� ",ia� immedialely surrounds
fown,
Record number � Page
al property ❑ Mobile Homo p.C. 6f.7-n
is usetl to produce income, tlescribe the use and poNOn
�����°""�;�:..,�i��`z�?*;�-'�,��,�-":STANDARD:DEDUCTION ALI:OWANCE�_�=��-"�e�,`,�a„fi�� -'�i�; � 3w ���'���°'��,-
�t, . v
20 _ Pay 20 _ � �
Lesserof 1/2 Homestead
vawauon or 535.000
5
Sgnature otNidilor ' � Date s'gned