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STATE FORM 53569(R2/5-09) TREASURER FORM TS-1A1
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 105-1.1-22-5 I
I - • MI 0 II 4NF4tr I€C-1/(l) HOM! AD "OP CIIVN
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
'auction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
eauses 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 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.
: • • - PA114 PROPER. 1r IN 0 RMATION ' ,'
Taxpayer Name Properts Address State Parcel Number Lepel Description:
Jack B/Patricia M Dunn 647 S State Road 57 26-14-18-101-000.271-006 FARMER&SON TRACT 3
Oakland City IN 47660 C-I
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
I ART 93`12WASI1i111 iNFoRmArioN• t,_
Ant Middle Last
Owner I
-Loan
Mang Address(number and street,city,state and ZIP code) add:911
62_( Rd. sff-/ auft(vEis z\1766 D
. —
Spouse First Middle Last
01/43— hik/kt- r)
t---t Pilastmi
Mang Address(nurnber and street,aly,state and ZIP code) Mr Same 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
.
•
CLAIM FOR HOMESTEAD PROPERTY TAX
d
CREDIT /STANDARD DEDUCTION
•` State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT
FORM
HC10/
YEAR
I (We) ���de�rs �Q�_Jl�/ertify that on the 1st day of March , 190 r
I (N'e) oc pied as our principal place of residence thhe/folowing described real property for which a Homestead
Platy 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 the
property or is buying it under a contract.
CONTRACT RECORDED
on coAradt7Fee StmWOwner's Name
Recorder's
PROPERTY DESCRIPTION
Record Number
County Townships _, �� I Taxing District (City, town, township)
Parcel Number Legal Description ll -4 aj ,
H_
por ion of the residential structure or the land not exceeding one (1) acre that immediately surrounds
lure is used to produce income describe the use and portion of the property utilized to produce income.
_
/4/-/,f- /) / -4 1-71-C,_J6
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Townshin I _ County I Town
h 'w certify the above statements are true, correct and Sign ur
co. te.
Address (Street, number, city, state and ZIP code)
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other land
Total land - line (1) plus line (2)
Residential improvements Dwelling
Garage
Other improvements
Total improvements - line (4) through line (6)
Total value - line (3) plus line (7)
(1)
1991 Pay 1992
19 — Pay 19 —
er of 1/2 Homestead
(2)
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Valuation or $2,500
(3)
Valuation or $1,500
Valuation or $1,500
(4)
Signature of Auditor
(5)
(6)
(7)
(8)
I hereby certily the above is true, Signature of Assesor
correct, and complete
Verifying Action - Signature of Auditor
Date Signed
Date Signed
cTAnrnADn nCnIIrTInM Al I nWANCF
1989 Pay 1990
1990 Pay 1991
1991 Pay 1992
19 — Pay 19 —
er of 1/2 Homestead
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Valuation or $2,500
Valuation or $2,000
Valuation or $1,500
Valuation or $1,500
I I'
Signature of Auditor
D�1e Signed