Homestead_Blair I STATE FORM 53569(R3/5-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE ICS-1.1-22-S.I
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
'eduction 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.
PROPERTY INFORMATION ;
PARTL
Taxpayer Name Properly Address State Parcel Number Lees)Description:
Kelly T Blair 1050 E 50 S 26-13-11-000-000.465-006 PT S SE 11-2-9 4.44 AC
OAKLAND CITY IN 47660 C-I
Ca:np:cteCar:return to: I®IIM(II MII[RQEQII11Iml11ll1m[I]CVI]IOILII3VV
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
1 PART 2: TAXPAYER INFORMATION a : liM1
Owner 1 'i ( First �— made Last
krj �e / l ,foil re 1a ( i
Mailing Address(number s I. y,state and ZIP code) r 7 I Same as property address
.O SO L h ,
Spouse First Middle , Last
M a EranCj B (a t r
Mafi g Address(number and street(c+ty,state and ZIP code)
Same as property address
"7 '7s / OS �- L O Pjand C
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
• kA 1:3-3) el i / ---- ;
INC:"T .., t r..:I..:W :NY -. :s : ,,:PA•'1 4:°'ADDITIONAL INFORMATION
FILED
6 NOV b 2012
GIBSON rill miry AOr•TG)R
•
CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION Hc�o
State Form 5473 (8614 -03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing inshwbDns.
J
YEAR
1i
I (We) certify that on the•tst day of March, 20
1 (We) occupied as our principal I tbg e idence the following described real property for which a Homestead Property Tax Credit is hereby 4-it ed:
❑ I (We) owned ❑ Are nder co ntract JUN 0 a 1006
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
If buying on contract, Fee Simple owners name
contact is recorded
Record number I Page
e ai-7'arAMrPROPRTY,OWNED iY CLAIMANTIN'OTHER'COUNTIES
Court
Toenship
Taring district (dry, t , r ip)
Parcel
Signature of claimant
Legal description
7
he property in question
M3 CoY
6 5 '
eel property ❑Mobile Homo (LC. 6f.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre mat immediatey surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
3 - /- Oo -oar• 5`�,� Oaf
e ai-7'arAMrPROPRTY,OWNED iY CLAIMANTIN'OTHER'COUNTIES
v --T- -
TRUE TAX�3.y
County Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
ess numbered stree(c tafe, ZIP code)
^
�i€.' 6VALl1E,w�a`.,x
i `•5�sn a k2�?.,''+.°q',. @"rj,. $' .' •
P-- vASSES50R USE ONLYn
v --T- -
TRUE TAX�3.y
°"' •^.r
ASSESSED VALIIE.,',.HOMESTEADT
c
- -y.-T•co,irR _
s 'NONRESIDENTIAL .
't'rrk`;s.VALU 4
r•, .sr' 1. ,;»r G,- Y+'a�f 'diL yt.1 -...' . - -{ :..
.: uVALUE
AT.�700'y °.. 0 N .da
�i€.' 6VALl1E,w�a`.,x
-
f
Land not eeeding I (one) acre immediately
surrounding residential improvements.
(1)
'SFr' - ; ` •1WO
1 -w
-
Other land
(2)
, A
Total land (line 1 plus line 2)
(3)
'Residential
Dwelling
(4)
it
�ZQ KM --
improvements or Annually
:'f
Assessed Mobtle / Manufactured Home
Garage
(5)
,.,
Other improvements
(6)
�r
Total improvements (fine 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(6)
1 hereby certify the above is true, coned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
Vautman or a35.000
S
I