Homestead_Phillips (4) STATE FORM 53569(RitS-10) TREM:ORERFORM TS-I A
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-8.I
YL wa .
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS aj
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
"°duction 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..T4 -‘4^10.1.7: °•
Tamaver Name Prooerty Address State Parcel Number J.evsl Description:
Orian Phillips 106 S JEFFERSON ST 26-12-08-301-002.057-028 HIGHLAND HOME 51
PRINCETON IN 47670
Cinnpk;e and r to: I"'.91�V.'L''L'°!I'f'llrn�nu�ni90!!!�I�Ilnili9l�p!�uwim1�8L9
IB I 1 11 J 1 LII WIF m F r 4 r r
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
=. r PART 2: TAXPAYER INFORMATION+; TV,-.
Owner 1 First Middle Last
ORIAN 7), �iti��lPS
Mailing Address(number and street,city.state and ZIP code)
bcI Same as property address
0 S r 5tc 'r4
Spouse • . First - • Middle Last
Mailing Address(camber and street city,state and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivels License/State ID Number(last 5 digits) State Other(please specify in Pan 4 below)
Rte' rs y 1The- T_3 -CERIEICA CLOOL 4 w .w x ^si` tnG�4? 7 Qft'7F7�t
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
•
'' t °Et _ s PART,43 ADDITIONAL-INFORMATION,
FILED
NOV 1 3 2012
GIBSON COUNTY AUDITOR
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
♦ State Fam 5473 (R6 / 4-03)
PrescriEed by lhe Department of Loral Govemment Finance
INSTRUCTIONS: See reverse side lor Filirg instruUions.
��l YEAR _
FORM
HC10
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� �we� � �
t day o( March, 20_
I(We) occupied as our principa lace of reside Ihe following descri e real property for which a Homestead Prope�-Ey�T�c�Cre��� reby daimed:
❑ I(We) owned ❑ Are buying under wntrect GIBSON CO�UNTY A DITOR
� Have a beneficial interest in the entity ihal is liable for ihe property taxes on Ihe property and Ihat owns the property or is buying under a contract.
If buying om m�Vad. Fee SimD�e ownefs name
Recofdefs olfice where coniraU is
Tamship
ParpB�nyrt�r���� � I Le9al descriDti�
U I `(
If any portion ol Na resitlentlal sW dure w che land not exceeding
ot ihe p o�WizeO b yoduce i�ome.
�
o?G /a -D� o3o�-a��_n,
Tacing distnc� (city, fown,
( Is Ihe pm
(1) aae Ihat immediately surtounds ihat sW�
� oa�
Record number � Page
al pmperty ❑ Mobile Homo (I.Q b7.1-7�
is usetl to produce income, describe the use and portior�
�"�e^ri'i �� � ' m�7E"�:'3-ia.� � .� 2. rsu_ � .-, lp - � �4 4 ' -x . re - w- � v .:
'u-3-"��°'>'ASSESSORUSEONLY�r�as ��.SRUETAX.i� ASSESSEDVALUE�HOMESTEAD ' NON�-RESIOENTIAL }r-#
a�yS�4.� h"'".e.tk,�x:�."�'�' �a�?�'"t.-.�i:�'� -i`�' 'z'VALUE>b.i.'0r„�i� �. AT 100%'OF,pTN.! .�K�<,VALUEA�.y''� �_ °tn�- VALUE�:'a en^'�a-.��
' u�:a. � ..�..5w
Land not exceeding 1(one) aue immediately ' �iss,��,t,$f.�'`���"�"'`�'�' Q'i.,4F'��
surrounding residenfial improvementa ( � � �" � �`� �i"'�"' '
r�--��.��>� �'?�=s
Other land (p) �{���� �,.'�-a�.� y
-v�+J.:�
Tdal land (line 1 plus line 2) (3)
i�u-,�`r. •,... . v::; � :§er � u]
Dwelling (4) �"���x�`` � ���5
�Residendal improvemenLS or Mnuatly ���� - ""�''`�'-°' �
2ssessed Mobile I ManufaUUred Hartce Gara e (� �� +E ' +-�� ��
9 5 �'`-'.^����`+�-�.... :45.�:.,�- - ` � , r
Other improvements (6) � � i
t� ikc���*�
Total improvemenis (line 4 fhrough line 6) (�)
Tdal value (line 3 phs line n (g) �
I hereby certify ihe above is We, correcf, and Sgnamre otnssessor Date sgned
complele.
Veri(ying action - SgrmWre oflwditor Date signed
20 _ Pay 20 _
Lesserof ti2 Homestead
vawauo� or 835.000
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