Homestead_Moore STATE FORM 53569(0.3/6.10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE ICbl.l 22.8.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS .
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
lb'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.
PARTI-PROPERTY INFORMATION - -::''.ljT
Taxpayer Name Property Address , State Parcel Number Leval Description:
Johny A Moore 2175 S 1200 E 26-14-19-300-001.345-006 PT NE SW 19 2 S 1.274 A
OAKLAND CRY IN 47660 C-1
Complete and return to: 0111110E0111,MIPIEMBIEBEITIIIIM
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2: TAXPAYER INFORMATION -
Owner I First Middle Last
SL:\RN.3 u 4 'ffinim e..
. Mali.-g Address(ranter and street,city,state and ZIP code) (v (Same as property address
41 i c s 15cn0 n-li:U d. CA-
spouse' First Middle Last
0,e0)uie I— In Mi.-Q-Maili g Address(number and street,city,state and ZIP code)
Same as property address
ails .s la(VN r_ ()A-MAAY (L1= i..1J 141AIOI
. <_. ._•
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.
aCyrri-v. a‘Owner1 Signature Date
FILED
DEC 11 2012
c.
GIBSON COUNTY AUDITOR
46% CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT /STANDARD DEDUCTION Stale Form 5673 (R215 -92)
s �
yu
INSTRUCTIONS: See reverse side for filing instructions.
' 'V CERTIFICATION STATEMENT;-,,
I (We) f' DZ7'�e certify tWon the 1 st lda��l�4yk�larch, 19
' tWe) occupied as our pri al place of residence the following described real property for which a Homestead Propel to "Adl Reu by dai
I (We) owned ❑ Are buying under contract 1 11"`
L� Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the q�erty or,4 - 1Ilvo@ract.
_. CONTRACT RECORDED
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
- - PROPERTY DESCRIPTION - _ :•' - -
Coun
To
Taxing district , twin, township)
'Af
M 4'fl
Si a re claimant
Parce n ber
02T 013Vf =0 C)
Legal description
It any 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
of the property utilized to produce income.
- /C/-/9 -�jt a,o
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
'hereby certify the above statements are true, correct and complete.
Si a re claimant
udress (number and street, dry, state, ZIP code)
R 2. �30 y b R K 44 yd 0 2 :. -41 766
ASSESSOR USE ONLY -
TRUE TAX
VALUE`
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL-,
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
2.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
- -
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pus line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor Date signed
- STANDARD DEDUCTION ALLOWANCE'
19 _Pay 19_
Lesser of 1/2 Homestead
Va r n or $2,000
$
Signature of Auditor
D g signed ed
_ I