Homestead_Falls (4) STATE FORM 53500(R3/S-10) TREASURE"FORM TS-TA
APPROVED BY STATE BOARD OF;MOMS.94 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOER MENr MANGE IC 61.1-331.1
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Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and married couplevare limited to one homestead standard deduction. As the receipt of this deduction becomes
Princeton, IN 47670 , more beneficial,there is more incentiie than ever for homestead fraud.Homestead fraud causes higher lax bills for all;therefore.
HEA•
benefit t and to requires taxpayers who receive the homestead standard deduction to gorier 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.
PART I: PROPERTY INFORAlATION•
JUN 15 2011 - D ,,— Taxpayer Name Location Address
C ).rr V Falls, Richard A/Calhy L
— GIBSON COUNTY AUDITOR - - 9653.E 450 S -
OAKLAND CITY IN 47660
1593 �I��II�
Richard A Falls II I�III_uiii IIII_III it IIII1II_IIl0I o_III DIIn1_I111_II�IIliI II II_VIII
9653E450S
OAKLAND CITY IN 47660-7654 -
IIIIII'l"'IIII'IIIIIIIrI"I'Ihl"IIII"Ill'IIIIIIIr'ili'IIIIIII State Parcel Number - Legal Description
26-13-35-300-001.484-006/PT Sw 35 2 9 6 AC
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This form MUST be returned to County Auditor's office.` .
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2:TAXPAYER INFORAlATION
First Middle Last
Rail_ m a_s
Mailing Address(number and street.city,state,and ZIP code) -Same as property address '
CAmy ,Lt5
— l xd ——
Marlmg Address livllmbcr and—sncetiity,state,and 7.IP code): - 12-Same as property address - . - - _ -
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is tale 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 maybe liable for back taxes and substantial fmancial penalties.
Owner I Si a / 2 /- - ,> Date'
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION Hcio
Slate Forth 5473 (R8 / 7 -07)
r.w Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions. T1 T T g1 'T_%
I (We) certify that otAV1 swig Mch. 20_
1 (We) occupied as our principal place of resident a following described real property for which a Homestead Property Tax Credit is hereby claimed:
11 I (We) owned ❑ Are buying under contract �'(��j�
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the p,8 fg � lynddrjmntraq.
CONTRACT •'D
If buying on contrail, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
County
Testing district
6-2, a ,,.,I • IU1 Legal
l[AAOd par ` U&4J �'a. 1 115 Ihel 0 Rea property ❑ Mobile Home (IC 61. 1-7)
If arty 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
d Vne property utilized to produce income. & Aw
ASSESSOR USE ONLY
TRUE TAX VALLIii
PROPERTY OWNED BY CLAIMANT
County Township
IN OTHER COUNTIES
County Township
1 hereby certify the above statements are true, correct and complete.
signature of claimant
47 (number and street city , state, and LP code)
ASSESSOR USE ONLY
TRUE TAX VALLIii
ASSE9SED VALUE
HOMESTEAD
NON-RESIDENTIAL
AT 100% OF TTV
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (lime 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
.'.a
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (Me 4 through fine 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed (month. day, year)
complete.
Verifying action - Signature at Auditor
Date signed (month, day, year)
L Pay 20 _ 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 12 44,000 for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead Valuation $
or 43,000 for 2009 pay 2010 40,000 payable after 2012p
Signature blAuditor .r -m " ... V, A . . - ���[ _ (.r A Ito year)