HomeMy WebLinkAboutHomestead_Sirmans SATE FORM 55569(R3/S-10) TREASURER FORM TS-IA
APPROVED BY iTATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOLL GOVERNMENT FINANCE IC61.1-2222-3.1
~ 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
0'auses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
s_ .,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.
;- PARTI: PROPERTY INFOILMATIO\
Taxpayer Name Property Address State Parcel Number Legal Description:
Billy R Simian 618/620 S RACE ST 26-12-07-403-001.983-028 SUMMERS ADD 46
PRINCETON IN 47670
Complete and return to: II@1IHll911FI]I)1m�ID1000 II�D]I EIEImll➢Il®
GIBSON COUNTY AUDITOR. 101 N MAIN PRINCETON IN 47670
LLu LLll
.1;_` . . PARP-1:,,TAXPAYER INFORMATION-.'.
Amer 1 First Middle Last
8 1 11 y R - Sir m re-r\5
Mating Address(number and street,dry.state and ZIP code)
I n °" I �I Same as Property address
lP - 1p 1 8 5 oc c h ROn- S- Pri n c eAA-ar Tyr, 4776-70
_
First Middle S 1 r m 5- last
Mailing Address(nunber and street.city,state and ZIP code)
J Same as property address
(02-0 -- bI51 SoU4-11n Rae'e- St Prineed-av, I y;7C7d
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
PART 4:ADDITIONAL I'.FOR\IATION -
_ AILED
JAN 31 2013 -
GIBBON comay
CLAIM FOR HOMESTEAD PROPERTY TAX
- � CREDIT/STANDARD DEDUCTION
State Fwm 5473 (R8 / 7-07)
��.�. � Prescribed by Iha Departmeirt af Local Govemment Finance
INSTRUCTIONS: See ravarse side /or fili� insLuctions.
�� FORM YEAR
�1 H
JL '
�(�Ne) y � certi n the oi March, 20
I(VJe) occupied as o prindpal place of residence tlie fWlowing described real property for which a Homesteadry m� ac Cr t�t is hereby daimed:
� I(We) owned ❑ Are buying under contraG GIBSON COUNTY AUt5iF4R
J Have a benefidal interest in fhe entiry ihat is IiaWe tor the property faxes on ihe property and that owns ihe property or is buying under a conhatt.
If b�ry4�g on conVacl, Fee Simpa ownels �mme
Recardefa of6ce where coniraq is recorded
Counry � ' Tnmship
Pa(cd number
legal
Is Uie
fown.
Record numbe� � Page
I�K . J�� �l/TLC3� �Real property ❑ Mobile Fbme (IC 67.7-�1
tt arry paUon of ihe reside�nial suuaure or tha Wd nd �ceedirg one (t) acre ihat "unmediatety wrmunds thal � re is used in produce inrnrtre, describe the use and pwtion
af Ihe property uGGzetl b pmduce incrnne.
01� -/�-Ci % a'3 - Gb/ �.3 - D�
Counry
I hereby certiy the above statements a2 We, correct and complete. ""
_ 2 ,��-- �
rass (number sVea4 aty. afafe. enU7lPcatle)
lai4 �zo 5(�;6s�,.� 5-�— P��'.���� �N Y�e �70
LarM not ex�ng 1(orre) aae immediately
surroundirg residential improvements.
Other land
Tdal larnl (1'me 1 plus Gne 2)
Dwelling
Residendal impravements w Mnually
0.ssessad Mobile / ManuFactumd Home
Garage
Other improvements
TUai improvements (line 4 fhrough Grre 6)
TUaI value (line 3 p!!s Grre n
I hereby wrtiry the above is We, corteG, and
complete.
Vairyirq atlion - Sipru Wra of �tur
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(Z)
(3)
(4)
(5)
(6)
(!)
�8)
Signatura of Assessw
20 pay 20 _ qs,ppp for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 1/2 qq.000 for 2008
Homestead Valuation PeY Z009 4�•000 for 2011 pay 2012 $
a 43,000 for 2009 pay 2010 40,000 payable aiter 2072
SignaWre N Audtor
Date signed (month, day, yea�
Data signed (mm1h. OaY.Y��
day,