Homestead_Nelson (5) STATE FORM 53569(R3I8-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FLNANCE IC6-1-1-222-8.1
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
anauses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
dard 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.
1 : PAR 1: PROPERTY INFORM. JON
Taxpayer Name Property-Address State Parcel Number Legal Description:
Hyojea Nelson 319\\`WALNUT 26-12-07-103-001.728-028 FOREST PARK 5PT
PRINCETON IN 47670
Complete and return to: 1E1101IJD111110111JII1fIllf11 110111 I1 11111UIDEERflgl
`-- GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 II�LL� 11 111 J'1 11 111117W
.
PART 2:TAXPAYER INFORMATION
Ovmer I i Middle Last
Mi
y o • Jed AitiS a n
Mailing Address(punter and street.city,slate and ZIP code)
1 Same as property address
-we First Middle Last
Mailing Address(number and street.dry,state and ZIP code)
Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Nester(last 5 digits) state Other(pease specify in Part 4 below)
- 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. •
pwnr-t Signature Date
( )
PART4:'ADDITIONAL INFORMATION
FILED
9 DEC 11 2012
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• GIBSON COUNTY AUDITOR
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"'" CLAIM FOR HOMESTEAD PROPERTY TAX � YEAR
� STANDARD / SUPPLEMENTAL DEDUCTION -
S a State Form 5473(R12/6-09) ' H
�O � PresrnbeC by the Department of Local Gwemment Fnaxe
wsrRUCnoNS: seB ��arse �ee ra� er,� r�sr,,,��bn5. J U L 2 9 Z O 10
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I(We) certify ihat I(we) occu ed as our 'pal
place of residen or am ( ) buying the following described real property tor which a Homestead Property Tax Stand�lB�efi �i�y ��b
under mnVact on Ne da[e this appliqUon is filed, (tlate o/filing):
❑ I(We) own ❑ Am (are) buying under recorded contract
❑ Am (are) entltled m occupy as a tenant-srockholder ot a cooperaUve housing corporation
� Have a benefictial interesi in �he Wst or the right to occupy Ihe pmperty under ihe tertns af a qualified personal residence Wst
•• � •
Name10 Wimant ( I name)
l
Sacal
Sorial Seamry numba ol daimanYs spause (last five d'gifs) Drivers Grense / IEentifiralion / ONer number Issuing Sate
of da'unant's spouse (last five dgits)
• ••� �
11 Mrying om m�Vaq Fee Simple ownefs name
RemrEers ofice where mnVad is recdde0 Remd num6er Page
. _ � . - � . �
Counry TownshiP Tarirg disiria (rify, rown, townchiP)
��cG/��n ber /� '/�/ al d/�� p�y Is Ne pmperty in queslion:
6� � V � I VrY � I �_ VP(� ❑ Rea� P�VenY ❑ Mnua�y a55es5eA mobile home (IC Ef. f-n
�If any ponion ol ihe residential sWCW re or Ne iand no/l ex�ceeding one (1) aae thal immeEiatey surtountls ihat swcnira is used m produce Ixorne, Eescnbe the use aM portion '
ot the P�PenY utifaeG to pmduce income. y� V wr\ `�S �
{
• � � • � : • •
Counry TownsltiP Counry Township
i hereby ceNfy the above ststements are we, correG and complete. 9 � °1�'�
.
Address(numberarMSbeet.crry,slate,aMLPCOde) ^ ��
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.- .
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Land not e:ceeding 1(one) acre immedlauly --`�u%�s �� ��-� °r 3-i���°-�`-','y
sunountlin residentialim rovements. (�) `��`-'_�-���+�T-"w''�n�=�--�"
a`�.�?,`..+�`r'1� S>'
Other land (2) ',`� _�. .r..y.•�d�.p •
Total land (line f plus line 1) (3)
ResidentlallmprovementsorMnuaity �����9 (4) �:.�s�'�'`'s '�`��i��'`�.f�a ^�'"`;i-eiv'$
AssessedMobiklManufacwredHoma Garage (5) �;=;�.���r�*',F-.,.'��s:�`��'i�'z
s a `� •
otherimprovemenss (6) ?� :,�?�"aJ�-�,�'�
Total Impravemenb (line e lhmughllne b� (7)
Total value (Itne 3 pl�s Ilne n (8)
I here6y certify the above is true, correct, Sigrewre of Asseswr Date signed (month, deY.Year)
and wmplele.
Vaitying action - Signature allwdtw Date s79neC (rtwnlh. tlaY. Y�A
�..� � � � •
20 _ pay 20 Lesser of 60% of Ihe assesseE value of the homestead or $45,000
NWy.9NS}��rg enY otherP���. Ne wm o! fhe deductions providedln IC 6-f. f-f7 ro a mobde home Ihaf is $
not essessetl es real pnparryar ro a rrenufaUwed horre Nat'a not assessed as ieel properry mey not erceetl .
onehaH (1R) olNe assessed rdlue a/ the mobde Aome or rtrenu/actured home.
SSriature W Autlitn Date 5i9neC (mmfi. EaY. YEa�