Homestead_Mabrey STATE FORM 55569(RMS-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1 22-5.I
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS 40'
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
'aduction 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.
PARTI PROPERTY INFORMATION ` Y
Tasnaver Nam{ Property Address State Parcel Number Less!Description:
John P Mabrey 207 S DIVISION ST 26-13-19-204-000.095-005 PT SE NE 19 2 9.4377 AC
FRANCISCO IN 4764.
7649
Complete and return to: II(llhIUDICIM6Ellllllll7[I11QIJII9ll II1111IJI1uh111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2: TAXPAYER INFORMATION-%:
Owner I First Middle Last
Maiam,Address(number and street,city,state end ZIP code) Ir Salve as ceopeny address
2• o7 c. 9Jvisioh ' ' Ffrafrlc,yca . . .✓ 476E/9
Middle Last
Mailing Address(number and street,city,state and ZIP code) I Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number(last S digits) sate Other(please specify in Part 4 below)
✓—>,
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 ipnaMe � ' Date
1 ( )
"� PART 4;ADDITIONAL INFORMATION
I ED
• NOV 192012
GIBSON COUNTY AUDITOR
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 IRS 14-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
FORM
HC10
.1 1 k]
I 'Tr mss-
YEAR
)Ij -- - — certify that MAUyNgfitrch, 20
;e win
:(1WW:))oC,Cupiedaso principal place of residence the followin e cribed real property for which a Homestead Property Tax Credit is hereby claimed:
W r7pa
e) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns theopMSM (6j errt)(;vritract.
NTRACT.!RECORDED-F!
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Record number Page
PkOER TY
_ P A- RJIRTION- - - ���;�o,&
County
Township 1�17
9 (cif , town, township)
Parcel number
Legal description
Is the property in question:
ltATY_100WOF,7Y
AIF
y '150t
1 -1 property ❑ Mobile Homo (I.C. 61.1-7)
If any portion of the
-ding 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.
cl
surrounding residential improvements.
55 3s'! PROP EkTY-6WNECFBY
County
Township
County Township
I hereby certify the above statements are true, coff act and complete.
a>pe7 claimant
'Mrass (number and street, city, state, ZIP code)
Rr.
' ' ASSESSOR UE ONLY - - --
TRUE ;TAXI -S
ASSESSED VALUE
HOMESTEAD
''---VALUEj
ltATY_100WOF,7Y
WO
Land not exceeding I (one) acre immediately
cl
surrounding residential improvements.
0
Other land
(2)
Ac
Total land (fine I plus line 2)
(3)
Dwelling
(4)
4
lift'Residential
improvements or Annually
Assessed Motille/Manufactured Home
Garage
(5)
I
-atf r, is
Other improvements
(6)
X% r-AX
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(8)
I hereby certify the above is true, correct. and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 1/2 Homestead
Valuation or 535.000
Date signed