HomeMy WebLinkAboutHomestead_Medcalf STATE FORM 53569(R303-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOV ER.NMENT FINANCE IcI-22-8.1
.11:6-1,
IMPORTANT NOTICETO HOMESTEAD:PROPERTY-OWNERS
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
uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
s audard 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. • //
PARTI: PROPERTY INFOR\1A ION
Taspacer Name Property Address Slate Parcel Number Legal Description:
-
Raymond Glenn Medcalf 716E OAK ST 26-12-07-202-002.141-028 PT NE 7-2-10.25 AC
8h •
Complete and return to: I1 i1/2 ct f on/ .1./1/ L/762a i111iiom11uu1mm®mmmmu uomoMmuum®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2c TAXPAI'ERINFORNA'FION . - ' ,
Owner I First Middle - Last
tl/nlahl� GIek, / e_c-icc
Mailing Adless Inunter and street.city•state and ZIP code) Sarre as property address
' S20 E4cr oo Sr /arlylcef�., £4/ 4/767o .
Middle Last
Mailing Address(number and street.dry,state and ZIP code) Same as property address
Social Security Nunber(last 5 digits) Diners(icensefState ID Number(last 5 digits) sue Other(please specify in Part 4 below)
1
. PART 3:CERTIFICATION
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that hear 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
(
PART 4:ADDITIONAL INFORMATION
FILE "),
DEC 28 ?O'd_
L.3.In -r
CIDCON COUNTY AUDITOG
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANOARD DEDUCTION
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'e) certify ihat on tlie 1 st Qay of Marcfi, 2(1_
'\e) ocapied as prmdpal place of residence the to8owirg d real property for which a Homestead Propaty Tmc Credit is hereby deimed:
YM�e1 owned ❑ Are buyug unda mntrad
Have a Denefidal citerest m tlie entity tliat is liade fir C�e propeny taxes m the propeAy ard 9iat owns the property or is buying under a cantrad
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I hereby aertih ihe above is true. oaref3. and s6�mae of Asseaar Date sgiee
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Yailyirg etlWn - SigreLre o1h��nr Date signed
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20 _ Pay 20 _
Lesser of 12 Homestead
VAua6m or f35�000 E
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