Homestead_Mosier STATE FORM 53569(R3/8-10) TREASURER FORM TS-IA
APPROVED BISTATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I 122-8.I
` = 'IMPORTANT NOTICE TO 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 ndard 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 INFORMIATION' -
Teases Name Prooern Address State Parcel Number Len!Description:
Blake C Mosier 515 S RACE ST 26-12-07-4031-000.061-028 SUMMERS ADD 34
PRINCETON IN 47670
Complete and return to: 111111101110 OIIIa®�IffO�lp®®m11IlIIl���m®
GIBSON COUNTY AUDITOR. 101 N MAIN PRINCETON IN 47670 LLII W_ CCIIt
�N �
PART.2. T.1:CPAYER L\FORMATION - '_
Owner 1 First Middle last
81 l<L C.J1 S±OpAL SS,It
Malting Address(number and street.city.stale and ZIP code) I Sarre as properly address
First Middle that
Ems ly —3o
Mo
Mailing Address(number and street,city,state and ZIP code) I Same as properly address
515 S ' ' CC sfi • Pr ‘- rtce in . LieiG70
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
8.)% j)& rn� , , — 2 ( )
r: PART 4:ADDITIONAL. INFORMATION-'
110
Q
�� CLAIM FOR HOMESTEAD PROPERTY TAX
i� �� CREDIT/STANDARD DEDUCTION
, State Fortn 5473 (R2 / 5-92)
� �•u
INSTRUCTIONS: See reverse side !or (iling instructions.
_ - . ,. �... -•- .. . . —r:-neervn��
39
FORM YEAH
HC70
I(We) I��.liC.XJI J certiryl�at on_tHe 1dt;d�y�of�.4a'd
I(We) occupie as our principal place of residence ihe following described real property for which a Homestead P���q��JY TJax Cre1dit ips hereb�,
[f I(We) owned ❑ Are buying under contract -"� L� 199�1
� Have a beneticial interest in the entity thai is liable for ihe pmperty taxes on the property and ihat own�s (^he property o{ is �ing under a
/ u`% (�
�l '�-'/:; 17,. �
!l .� , ., . . 1. �
� _ - �. CONTHACT RECORDED . �f , - " "��'��- !
II buying on contract, Fee Simple owner's name
RecordeYS oHice where contract is recorded Record number
i. 7 9
daimed:
�1'>
Page
� � � - � ` ��PROPERTY DESCRIPTION . ` , . `, . . . ' .s ��' , _. . .
TownsNp Ta�cing districi (dQ; fawn, township) '
u Legal descnption
� I -C� 3 �
of the residen6al swcture or Ihe land noi exceetling one p) acre that immediately surmuntls �hat struqure is used to produce income. deuribe the use antl portion
y utilized to prOduce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES � �
Caunry Township Counry Township
I hereby certify the above statemenis are true, correct and complete. Signa;ur ai an� ,o
�ress (numberandstreet dry. s(afe. ZlPcode) � �
' "
i
. ASSESSOR USE ONLY � TRUE TAX ASSESSED� HOMESTEAD NON-RESIDENTIAL", :.
VALUE VALUE+ � VALUE � �VALUE �-.
Land nm exceeding 1(one) acre immediateiy � ° -
surroundingresideniialimprovements. (�) - ��
Otherland (Z) - �
rs ° �
Total land (line 1 plus line 2� (3)
Dwelling (a) � . �� o " � .
Resideniial improvements �
Garage (5) . " "
Oiher improvements (6) �
Total improvements (line 4 thiough lina � (7)
Total value (line 3 p�s line � (g)
I hereby certity Ihe above i5 tme, correCt. and Signature of Assessor Date signed
complete.
Veriyifg action - Sgnamre of Auditor Dare signed
� - STANDARD DEDlJCT10N ALLOWANCE' .= �
79_Pay19_ -
Lesser of ll2 Homestead
Valuation or 52.000 �
Sgnanre of Auditor Date signeC