Homestead_Haines (2) STATE FORM 53569(8118-1o) TREASURER FORM TS-IA
r, APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 106-1.1--2222-8.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS ° t g
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
ruses 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.
PARTI-PROPERTYINFORMATION
Tasvarer Name Proverb'Address State Parcel Number Leval Description:
Alan B Haines 1307 S 1050 E 26-13-14-400-001.278-006 PT SE SE 14 2 9 1.00 AC
OAKLAND CITY IN 47660 D-6-C-I
Complete and return to: BEE
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
. PART 2:TAXPAYER INFORMATION
Owner 1 First Middle Last
Mean Address(number and street,city,state and ZIP code)
Same as property address
1'?101S )69) 6. 0-141.1A(\, IAm ynldLa)
First Middle Last
Mailing Address(number and street,city,state and ZIP code) I Same as property address
Social Security Number(last 5 digits) Dawes License/State ID Number(last$digits) mate Other(please specify in Part 4 below)
•. ... ♦, _ t � _ _.'PART.3:C d ag
a:•Y d ^_.
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 - Data
;tom
•
FILED •
• NOV 7 2012
GIBSON COUNTY AUUROR
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION C o
State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions.
NOV 51992
CERTIFICATION STATEMENT
Xyt�ct -s
I (We) (�U `� certify that on the s . ay�6Wi(�R 19 1
((We) occupied as our principal place of residence the following described real property for which a Homestead
Property Tax Credit is hereby claimed: ❑ I (We) owned ❑ Are buying under contract
E] property 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
If buying on contract. Fee Simple Owner's Name
Recorder's office where contract is recorded Record Number Page
PROPERTY DESCRIPTION
County T n ip Taxing is ict (Cty. tpwn, township)
Parcel Number – Legal Description :SF I ��
If 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.
,-�Z- / / - o -GZ /. 2 742 ,2�6
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County I Township I County I Township
certify the above statements are true. correct and
nu
is
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—
Lesser of 112 Homestead
(2)
Lesser of 112 Homestead
Lesser of 112 Homestead
Valuation or $2,500
(3)
Valuation or $1,500
Valuation or S1,500
(4)
-
Signature of Auditor
�).
(5)
(6)
(7)
(8)
1 hereby certify the above is true,
correct, and complete
Signature of Assesor
Date Signed
Verifying Action - Signature of Auditor
Date Signed
STANDARD DEDUCTION ALLOWANCE
1989 Pay 1990
1990 Pay 1991
1991 Pay 1992
19 — Pay 19—
Lesser of 112 Homestead
Lesser of 112 Homestead
Lesser of 112 Homestead
Lesser of 112 Homestead
Valuation or $2,500
Valuation or $2,000
Valuation or $1,500
Valuation or S1,500
Signature of Auditor
�).
Date Signed
-S- A.