Homestead_St. Clair (7) STATE FORM 53:e59(R2/34J9) TREASURER FORM TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-8.1
'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
'pauses higher tax bills for all; therefore, HEA 1344-2099 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 accessedby authorized 'county officials . The Department-of Local
Government Finance will use this information to create tools that will help"county officials eliminate'
. - ' homestead fraud.'
Taxpayer Name Properly Address State Parcel Number Legal Description:
Lisa St Clair 625 S Stormont X 26-12-07-404-002.860-028 019-02860-00 KOLBS ADD 3/4
Princeton IN 47670
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
#"• ' PART 2: TAXPAYER INFORMATION .
Owner 1 First Middle Last
L15Pt f<o, / 51- e CICL,n
Mang Address(nunter and street.city.state and ZIP cede) • I P it are as property address .
Spouse Fist ' ,r .n. j
Bi 1 141 .) • . irn Son .:. `�t- Cilc `�U,�
IAa86tg Address(number and streel,city.state and ZIP code) % _ Sane as property address
•
'
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 I Signature Date
�_ /1 Li - I` /tom ( ) ��
- r PART 4:ADDITIO\AL INFORMATION, '•
•
. - . . - _.
CLAIM FOR HOMESTEAD PROPERT/ TAX
CREDIT/STANDARD DEDUCTtON
� Stste Form 5473 (R6 / 4-03)
PrescriEad by Me Department of Local Govemmeni Finance
INSTRUCTiONS: See iaverse side PorTling instnx6ons.
FORM � YEAR _
HC10
I(We) I ��I ��`Y/i `X/l/vV � - certi(y[haton�fl�Rst�ia�oW§Vth.20
I(We) occupied as o�r principal place of residence the following descnbed real property for which a Nomestead Property Tac Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under coniract /J
�—py���i� h�
� Have a benefidal interest in the enfity tha[ is liable for the property taxes on the property and Ihat owns the property dr is bu4itta�d�Aq��6lf�ct.
_ .,�AwnN COU�
It buying om m�irad. Fee Simple ownefs name
ofice where coniraa is recorded
Tamshio
number
Ta�ing aistrict
Is the
Rewrd number � Page
�����V �—� �u'd' ��Q al property ❑ Mobile HomO (/.Q S7.f-7�
If any portion of the resiOenUal sWqure or Ue land not axceeding one (1) aae Ihat immetliatey wnounds Ihat s re is useA to produce income, tlescribe the use and portbn
ol lhe properry utilaed b produce i�ome.
ity�r %��5. 5+.�`.�e.;zff �.t�"�.r.'�e < . g ,�b . „� -. ...s . - . . ,,...�� � .� . .. a r—s:c
`�v.`� �"ASSESSORUSEONLY'�� ;_3}TRUETAX„1s�ASSESSEDVALUE �HOMESTEAD� NON-RESIDENTIAL
tS`3`5��"�,�3Sr *.,�,30?�€::�ES.,�-r^`.-au� -'^� ��+�VALUEE�tia"..� ';�AT 100%'OF�TN S ��'''VALl1E�� ����:1�:,�.WVAI.UE �.�.i . E'��?'�
Land not exceeding 1(one) acre immediatety �. y�. .�;� �� r�%7�33 �
surrounding residenlial improvemenLs. (�) ���i �n �_v�������,�
���•X,aY,'.•=-- �S� .
Other land �z� ��-���i'���
Total land (line 1 plus line 2j (3)
4g�F`�`Y�'L�� � �� Y� . C<�
Dwelling (4) ti.����n��#���T+,�
�Residentlal improvements or Mnualry ��1 " `� �`
l�ssessed Mobile / ManufacYUred Home Garage �5) :��� -_ '����
��x �x'...�.. +�
!s`y.i_ ,.:, ,�.�,y.xi
Otherimprovements �6) �s's"i;-�;.•�,_,,�' �=
��t����
Tolal improvements (line 4 through line 6) ��)
Rtal value (line 3 pl�s Irne n (g�
I hereby certify the above is W e, conect, and Signamre otosseswr oate s"gned
complete.
Veri(ying action - Signature ofAuditor Date signeA
20_Pay20_
Le;;er ot 1l2 Homestead
VelueLOl1 w 535.00p
$