HomeMy WebLinkAboutHomestead_Pugh STATE FORM 53569(R215-09) TREASURER FORM TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1-222-6.1
a IMP.ORTANTeaNOTICE1.01.0OMESTEAD ROPERTVO VNERS t ', 4. "
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Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
1 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.
a;L g;,PARTI, iPROPERTY;_INFORMATIOIY x` X ig,ost iiss ty: t t�: , -:ate.;
Taxpayer Name Properly Address State Parcel Number Leal Description:
Bill R Pugh 923 N Main ST 26-12-06-304-001.307-028✓/ CHAS BROWNLEE 4 PT/5 PT
Princeton IN 47670
Complete and return to: I®IlffilR MEHOIU MI:ll DIDIIlll[J1IuIUg
IT Tir t GIBSON COUN.T-Y_AUDITOR._IOLN-MAIN.P.RINCF.TON-JN.d767n .
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4
1
APR. 2011
GIBSON COUNT n�4PAl/WrORrm MUST be returned to County Auditor's office. - o
- —Piease-do°NOT send-this-form-back with-yourtax-payment to-the-county-treasurer-.— -
I PART 2: TAXPAYER INFORMATION
Owner I . First - Middle Last
g( l1y _ IRA PuG1-i
Mailing Address(number and street,city,state,and ZIP code) 0 Same as property address
7;3 A/n 7-7 A4)4141 57" PR ) vet- ra,v, CA)D . 47 (07j
Spouse First Middle last
-- Same as property address -- - "---- --- - _-
Mailing Address(Numbei and street,city,state.andZl P code) _ _ `, - u-- .° 'N -_� P Pe^Y .
C.I.
Social Security Number(last 5 digits) Drivels License/State ID Number (last 5 digits) Other(please specify in Pan 4 below) -
1 I I I , I I I =UIe
IMEIMMEIMMIMIIMIC TIFICATION •
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
( ) -
1
i
�
r•—^• YEAR
a� " g CLAIM FOR HOMESTEAD PROPERTY TAX FORM
i?�'•� CREDIT/STANDARD DEDUCTION HC�o
„ y�y .,��� State Form Sa73 (R2 / 5-92)
�eL
INSTRUCTIONS: See reve�se side 7or /iling instructions. �
� � CERTIFICATION STATEMENT �
�Ne) _�_�=t' - certify that on the 1st day of March, 79_
z) occupied as our principal ptace of res nce ihe following described�real property lor which a Homestead Property Tax Credii is hereby claimed:
�(We) owned ❑ Are buying under contract
J Have a beneficial inierest in the entiry thai is liable for the property taxes on ihe property and that owns the property or is buying under a contraci.
� CONTRACTRECORDED � � -
If buying on contract, Fee $imple owner'S name . ,
Recortler's oflice where contrect is remrtled Record number Page
PROPERTY DESCRIPTION
Counry Township - - Taziaq district (city. tbwn, (ownship) - � �
Y —��,^
/P�arcel Gn�umber I Legal tlescription
lJ � 1 ' (���0� ' a� .
-li any ponion o�e residential stmcture or ihe land not ezceeding one (7) acre ihat immediatety surrounds ihat structure is used to produce income, descrihe Ne use and portion
of ihe prapeny utilized to produce income.
ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
. VALUE VALUE VALUE . VALUE
Land noi exceeding 1(one) acre immediately
surrounding residential improvements. (��
Oiherland (p)
i
Total land (line 7 plus line Z� (3) '
Dwelling �(a) �
Residen�ial improvements
Garage (5) '
Oiher improvements (6) .
Total improvemenis (line 4 through line � (7)
Total value (line 3 p�s line 7� (g)
I hereby certify Ihe abOVe i5 lrue, corrett, and Siqnature of Assessor Date signed
complete.
-�ving action - Signamre of Auditor Date signed
�,
STANDARD DEDUCTION ALIOWANCE
79_Pay19_ I
Lesser of 1/2 Homestead
valuation or 52.000 S
of Auditor