HomeMy WebLinkAboutHomestead_Potts STATE FORM 53569(RJB-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1 22-8.1
I'MIP0 X111 NO IC« -t1.f011(0GL=I11u) ' aOI .PE+R MOWN' ee•S
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
dila higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
s andard 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
fraud. •
PAR(I: G}D]1L11:305`I -
Trimmer Name Property Address Slate Parcel Number Leoal Description:
John R Potts 507 S STORMONT ST 26-12-07-404-002.848-028 MONROE HOMES 4
PRINCETON IN 47670
Complete and return to: 1[111111111113111011111111111191111111111EMODEBIlin11111111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
&4.821M111111 INFORMATION
Owner I First Middle Last •
Mailing Address(number and street,city,state and ZIP code)
Same as property address
XO7 S SAD/CM o/1/4l r
e First Middle Last
Madrg Address(number and street,city,state and ZIP code)
Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number(last 5 digits) 9ne Other(please speedy in Part 4 below)
RamathCERrTIFICATION .
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
F ■ PARS : Di IONAL INFORMATION
FT s'
JAN - 9,2013
7 t
GIBSON nnUNry AUDITOR
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
sm� ro�, sars cR� i soe�
Pres+meE by ihe Depertrt�ent of Loral Gwemrt�erq Fe�anoa
INSTRUCTIONS: See raverse side (or fi(ing instructions.
!L� 1 � FORNI� �
1'
Hcto-�
JUN 0 7 2007
i �,,,e� - �v r-- �- . l!-'«- Nma�c prn'rme i ue drI'aI�of March, 20_
I(We) oca as our prindpal pWce ot residence tlie tolbwing described real poperty for which a Homes s�roper�C��lis4i�reby dairred:
, I(We) owned ❑ Me buymg under crntrad
�riave a benefiaal interest m the entity that is liaae tor C�e propeAy tarzes m the property and that owns the property or is Wying under a contracL
If Wy'vig on m�tre0. Fee Sirt�le ownefs rmme
Recarde/s oifice whae mM+ad is recadad
Co�mry Tw�r¢hip
Parcd nuMer Lepal desaiplian
�
n �Y P�An o1 ihe resideMial sWChrta d the Imd nal ncceeding oi
q WapertY tN6mtl b proAuca mmme.
/
�..1-�d _ o�-�o y-oc��.
Twrnahip
Recud numher � Pege
ITa�9 E� (cdh: rown. fawnshfP)
� � /
L/ Is Ihe pro�erty in quas6on:
�i"�^�� 7 �proparty ❑ MobileFbme(I.C.6f.f•n
(t) eae that imrr�d'iatdy armunds Rrat � ia usetl to pmduca u�mme. describe ihe we end Go�n
sy8-o � i�
I he�eby oertify ihe above statements are true. mrrecl and complete.
�(nuMar end aheet d�1: sfafs. LP m0e)
�� � o� S 31'0 l� fYl � �/ i
Land not exceeding 1(ona) aae irtrnediately
s�mo�md'uq residential improvements.
Other IarW
Tdsl land (1'vre 1 pWslare �
D�vellirg
Residential imprwements ar Mnually
Pssessed Moble / MmMaWued Fiort�e
Garage
Other "unpiwernents
T�al vnprovemerrts (iire 4 through Gne 6)
Tdal value (lirre 3 pl�s Gne �
I hereby certify ihe above is true, carted. and
oortWlete.
Veiryinp aam - Signama of Audimr
1�)
(Z)
(3)
(4)
(5)
(6)
��
�8)
Signahae ot Assessor
County
�
Data aigned
Date sgned
'�-.�na4�3`S.�'`'�'�y'�,+�Sft.F'��7.,'���+`.`,,,�`.��:�t.. ..q"a;STANDARD'AEDUCTION'ALIOWANCE.' ;�X:�_;+Y.v�l.�.:.F ^'-��'`Trlil,,.�..n 1u��<`i::.��4:
. ��. ; ,. �[�`a�a.
20 _ Pay 20 _
Lesser o112 Homes[ead
Valuatim or 535,000 E
Signa�¢ue N /wdilu DaU signed