Homestead_Stoll (6) STATE FORM 53569(R31&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
e IMPORTANT NOTI'RE TO-N'O1M!ESTErAD PROI-PE?RTY OWNIE�RS
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
auses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
gta 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.
1BJ131Jfle • a PE• t Lbliffituzyijim
Taxpayer Name Property Address State Parcel Number Leval Description:
Judith Ellen Stoll 420 N'EMERSON ST 26-12-07-103-002.773-028 BROWNLEE ENLG 5 PT PT NW
PRINCETON IN 47670 7-2-10.25 AC
Complete and return to: 111l]I111111I11lf1]Il1110 1111If1I111011 11111111E1011][11111111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2: TAXIIAYwER INFAORMArTiloN •
Owner 1 First Middle Last
V t, trM t L S-ro
Mailing Address(number and street.city,state and ZIP code) Same as
property address
4-2 0 W. E V A 0 2 S,O N S 1 ) FIR I N3C.IMO/J H•1 47 in 7 O
S, First Middle Last
Mailing Address(number and street,city,state and ZIP code) Same as property address
Social Securty Number(last 5 digits) Drivers Lieense/State ID Number(last 5 digits) Sum Other(please speaty in Part 4 below)
•
Mar& ial �J ION • - •
-
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
( )
PARTa3ADDITIONALINFORMATION •FILED
DEC 27 Iii
GIBSON COUNTY AUDITOR
waM xc ia ism
Resttibe0 By SU�e BwrE of Tax Commissioners
To & FiICE in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT FOR YEAR 19L� �
SEE BACK FOR FILING INSTRUCTIONS Q�Q� A�oL% !3'��
�We — certify that on the 1st day of
March, 19� I, e) occupied as our princ� al place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial nterest in the taxpayer
Property Description in�� _ County ��� Township
Taxing District (City, T�wa�ewnship): �'—�—_—_�
Parcel Number
If buying on contract: Owners name �'� ""'o'e
or legal description shown on tax statement:
�`. i1/u/ v 7- a-�o . as
Contract recorded in Recorders Office - Record
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property:
�ereby certify the above statement is true, correct and complete
Stree� lbaress
County Township
����- �Q���:�� � � �� �a
Ciry. S ie ana Zio Coee
' Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in. the taxpayer.
Land not exceeding 1(one) acre�d3s��,
surrounding residential i�� 9
Other Land ,
Total Land
Residential Improvements AU��T�R Dwellin9
� - FOR ASSESSOR'S USE ONLY -
�� �True Cash Assessed Homestead
� Value Valuation Valuation
Other Improvements
T
I
provements - Line (6) plus (7) equals (8)
certify the above is true. correct. and complete.
Approved
(i) �oic
(3) ad i o
- ACTION BY AUDITOR -
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Date
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