Homestead_Tichenor (4) STATE FORM 51569(R21119) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF AROU\TS.Yq9 PRESCRIBED BY THE DEPARTMENT CF LOCAL OOVERNMECT FINANCE C 6-1.1-224 I
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 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 indentifying 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.
PART I: PROPERTY INFORMATION
Property Address(number and street,city,state,and ZIP code)
State Parcel Number j FILED
- 1�-1 - ioa - Doa• c2S E -[p.r oa g • SEP 19 2013
GIBSON COUNTY AUDITOR
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
•
- l� � z
I I
Mailing Address(number and stre city,s te,and ZIP code) Same as property address
•
Spouse First Middle Last
Mailing 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) Other(please specify in Part 4 below)
Sue
• PART 3:CERTIFICATION
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 '
-
INSTRUCTIONS N Pi-53• tic
dM�•, CLAIM FOR HOMESTEAD PROPERTY TAX
���, - --; ; CREDIT/STANDARD DEDUCTION
� State Form 5473 (R2/1-90) • -
'°�• . INSTRUCTIONS: See reverse side lor �iling instructions.
CERTIFICATION STATEMENT
FORM
HC10
�
YEAR
'f.
I(we) _���J_.d�(f�Y:�'JJ'YiDVt.c.e� ���Q"�ertify that on the tst day of March , 19 �_{�
�'We) occupied as our principal place of reside ce the following described real property forwhich a Homestead
roperty Tax Credit is hereby claimed: � I(We) owned � Are buying under contract
Have a beneficial interest in the entity that is liable for the.property taxes on the property and that owns ihe
� property or is buying it under a contract. �• -
If buying
recorded
Township
RACT RECORDED
:RTY DESCRIPTION
Record Number � Page _
Parcel Numba,� b Legaf Descrip n ^„�, 3�
� iq -('�a�sg �- � c�
Ii any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that struc-
ture is used to produce income describe the use and portion of the property utilized to produce income.
PROPE
cenify the above statements are true.
Address (Street, number. city, state
,
ASSESSOR USE ONLY
BY CLAIMANT IN OTHER COUNTIES
��
� .
TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not ezceeding 1(one) acre immediately " -.
surrounding residential improvements (�)
� Oiherland (2)
Total land - line (t) plus line (2) (3)
� _ Residential improvements _ Dwelling _ (4)_ .
Garage (5)
Other improvemenis (6)
Total improvements - line (4) through line (6) (7)
Total value - line (3) plus line (7) (8) ,
I hereby certify the above is true, Signature of Assesor Date Signed
correct, and complete
Veritying Action - Signature of Auditor Date Signed
1989 Pay 1990
�ser of 1/2 Homestead
Valuation or $2,500
STANDARD DEDUCTION ALLOWANCE
1990 Pay 7991 1991 Pay 1992 19—Pay 19—
Lesser of 1/2 Homestead �esser of 1/2 Homestead Lesser of 1/2 Homestead
Valuation or $2.000 Valuation or $1,500 Valuation or $7,500
Signature of Auditor ^ � y� � � �� I �e `
f n' M n� n �` �