Homestead_Parke STATE FORM 53569(R218-09) TREASURER FORM TS-IAI
APPROV,D BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC61.1-22-8.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
Indifiduals 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
`uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
s ndard 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
lit to Same PrnperrV Address State Parcel Number Legal Description:
John E Parke 2494 S 1200 E 26-14-19-400-001.077-006 PT SW SE 19 2 8 3.92 A PT NW NE
OAKLAND CITY IN 47660 30 2 8 C-1 tt��II11
Complete and return to: 1®IIDIMIKEflUI m��HImmlhlm1111®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
i PART 2: TAXPAYER INFORyIA'PION
Owner I First Middle Last
Mating Address(number and street.oty.state and ZIP code)
Same as property address
Last
Mailing Address(number and street,city,state and ZIP code) Same as property address
Social Severity Humber(last 5 digits) Diver's License State ID Number(last 5 digits) Sze Other(please specify in Part 4 below)
71, ° PART 3i:,CERTIFICATION .
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
•
( )
PART 4:ADDITIONAL INFORMATION
Y
CLAIM FOR HOMESTEAD PROPERTY TAX F YEAR
CREDIT /STANDARD DEDUCTION HC10
State Foen t-An (R7 / 5067
Prescribed by to Deperbrent d Lorvt Government Fnarme
INSTRUCTIONS: See reverse side for Kling insbbctions. _
CERWICATION STAIENENT,.' c ..,ocntJ cOUNTY'.P._ t.
I (We) U • " • certify that on the 1 st day of March, 20_
1 (We) own ' as our principal place of residence the following described real property for which a Homestead Property To Credit is hereby claimed:
Q I (We) owned ❑ Are buying order omtrad
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 under a contract.
. CONTRACT'RECORDm t•.. <.��, f ' 1 ' S+ � � h tr'•/ �t - a.
If buying on contract, Fee Simple awrmes naphe
Ractsdefs elks where contract is remded Record number Page
PROPERTY DESCRIPTION'`)
Canty
Tonalip
County
Tamlg debit (ray. Nan, Tlsf6p)
L/
Parcel nmbor
Legal description
/
la the
+\S4`� k�'..
W
Q
V ZG
❑ � pmpertY ❑ Mobile Home (I.C. 61.1 -7)
arty portion of the residential struchae or the land not exceeding
one (1) acre that anmedalely wrrounh that strwtae is used to produce iwme, describe the use and portion
the property ulif®d to produce itmme.
e2D0- 000.0%
-14-
q :yam -ail .6 7 - 1 -C-06
.�..: -. ,, elk
..'� � :;i-': PROPERTY OWNEDBY.CLAfYANTd�OTHBt COUNTtESr,. =s �'' .,,;1z- y'S+sr..�++vn :`v i,.. 044!.
County
Township
County
Township
I hereby certify the above statements are true, cartect and complete.
lr
less (narrter and street city did% ZIP rode)
2 S , 1200E- Oa L a ovao C z «O
` - { W ASSESSOR USE ONLY ; ;,
` TRUE,TAX ,
',ASSESSED VALUE
rSFSTEJID
;NONtES1�t71AL+y,,t
�' ?t+
VALUE,'
'A - 100 %�OF
+\S4`� k�'..
\
Land not exceeding 1 (one) we immediately
$IIfIOlaldRg residential improvements.
( )
.jr 1 1rr31 -1 \rfi �.`� >l:R rf.t5i
Other land
(2)
T
Rite! land (Ilre 1 plus fire 2)
(3)
I7we�rg
(4)
y .t Y
Residential lrhprovenherhts er Anrhualty
�ti; �,.��rv'• ° :N. "fur.;",+. c
Assessed Mobile / MerallaChtred Hone
Garage
l^+ r w4 wraa v t-r
(5 )
ly 1,
Other improvements
(6)'
.:
Tdal improvements (fore 4 Mrougii Erie b)
(T)
Tcbd value (fare 3 pls Erie 7)
(a)
I hereby certify the above is true, carted, and
Sigrmae of Assessor
Data signed
complete.
Veifyirg adion - signature of Auditor
Dale signed
STANDARD DEDUCTION ALLOWANCE
20 _ Pay 20
Lesser of 12 Homestead
Valuation or 535,000 S
Signame of Auditor Date signed