Homestead_Broshears STATE FORM 53569(R3B10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT fINA.NCE IC6-1.1-222.I.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 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.
h' PART': PROPERTY INFORMATION . A.414.309
Ta:paver Name property Address State Parcel Number Leeal Description:
Jason A Broshears 2130 S 1200 E 26-14-19-400-000.576-006 PT NW SE 19-2-8 5 AC
OAKLAND CITY IN 47660 C-I
Complete and return to: 1®110D]UV01BEE[110I 1ll IltlED11IIDH]IiUVV
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
I -PART 2: TAXPAYER INFORMATION ;:4-71:-.4
• /�/// Middle e Last
Mailing Address(number and street.city,state end ZIP code) ,�
/I Dime as property address
2130 I _vo = O - G/ GG d
arouse First Middle Last
Mailing Address(number and street.city,state and ZIP code) Same as property address
Social security Number(last S digits) Drivers License/State ID Number(last 5 digits) sue Omer(please specify in Part 4 below)
: _241174:_CERTIF..ICATTION neat 4:c. 1 _
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.
Date
( )
P? RT 4.AbDITIC!NAT INI9RMATIONi
41.
DEC 27 2012
GIBSON COUNTY AUDITOR
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Farr 5473 (R71 SM
Prescribed by ft Department of Local Governinand Finance
INSTRUCTIONS., See reverse side for Ming instructions.
Hub 2 1 2007
FOFWBSON COU y AUDITOR
HC10
CMMICATM UME1111113ff,: ',
, " . :4
I(We) \, certirly, dmQ6J sld"Jiitarch, 20L_
I (We) occupied as od principal place of residence the following described real property for which a Homestead Property Tax Credt is hereby claimed:
I (We) owned ❑ Are buying under contract 117 -7,641�
Have a beneficial interest in the entity that's liable for the property taxes on the property and that ciarris t119 tract-
00KTPACT;REC0FtDEDPe'
d buyig on mn4ad, Fee Simple owner's norms
RmmrdWs dim where contract is mcmded Record number Page
V.ir,,','PRoPERTYowmEdBy.cLAmmTtm'bTiiER'CM?tttES,
County
Township
County
mlw-�t—
Townhip
I
Swaw -art
Imang dWnct (cify, town,
I r_1
M'Vass (nurnber and sheet, Q*Sf3t9,Z1Pcoda)
�rntmnber
0
/L4-/5-4o0-0---
Legal Pbm
76 COG
.1 J
Is the property in question:
I !,;b� Property
❑Mobile Hone (LC. &1. 1-7)
Harry portion of the ran Hnntim sin, or the and not -m--ding one (1) acre dud irrunadmialy wirounds dud structure is used to produce incorre, describe the use and portion
at the property Mod lo Produce income.
V.ir,,','PRoPERTYowmEdBy.cLAmmTtm'bTiiER'CM?tttES,
County
Township
County
Township
I hereby certify the above staternents are true, correct and complete.
Swaw -art
M'Vass (nurnber and sheet, Q*Sf3t9,Z1Pcoda)
.1 J
Land not exceeding I (or;e) acre iffirnscliately
.. ... ..
A�� USE ONLY
ASSESSED
WA
�-NOJTEAD,
--%cW,4WW.D8MALgV
4, ON
Y ATV
.1 J
Land not exceeding I (or;e) acre iffirnscliately
sunuundinig residential improver nments-
Other land
(2)
Total land (Ike I plus fine 2)
(3)
Dwell
(ng 4)
Residential ffripromnerdsorAnnually
R�
Assessed Mobile I Manufactured Home
Garage
(5)
mW
�= N
Other unprovernerits
(6)
.6"t, 1,
Total intprovernents (Foe 4 f ugh foe 6)
(7)
Tclal value (Ike 3 plus Am 7)
(8)
1 hereby certify the above is true, correct, and
corrviete.
Signature of As
Date signed
Verifying action - Signature of Auditor
Date signed
20— Pay 20—
Lesser of 112 Homestead
Valuation or 535,000