Homestead_Price STATE FORM 53569(R3D-10) TREASURER FORM TS-IA
APPROVED BY5TATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE tC6-t.1-22-11 I
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS _�. A
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
•duction 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 :,' - )'. ;4r;_
Taxpayer Name Property Addresq State Parcel Number J.eeal Description:
Troy NI Price 10643 E 350 S 26-13-36-100-000.609-006 PT NW NW 36 2 9 5 AC
OAKLAND CITY IN 47660
Complete aad return to: IGI111GI1)J111110E9MINn I ❑I not
�18(1�l��I.>.I�I�a By G IM
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2:TAXPAYER INFORMATION
Owner 1 First • l l'(- ' a Middle 1 ._W Last
1 ro . 1
Mailing Address(number ind street,city,state and ZIP cede)
e as properly address
in c� �3 5 0
Middle Last
7 FeY Le
Mang Address(number and street,city,state and ZIP code) J ame as property address
16 (.P *3 G 3c-- ) 5
_! _ ',
Ecch 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 Signatur •" Date
.+'
• / f/
- _ -- - _ //
CLAIM FOR HOMESTEAD PROPERTY TAX FORbI
CREDITISTANDARD DEDUCTION HciD
Sam rvm 5473 (R7 / 5.M
Prescribed by the Depatrnent of Loral Goverment Finance
INSTRUCTIONS: See reverse side /or 67bhg instructions.
f. ... ...... ...:. . CERTFICAMON STATEtt1E►If
r; f
I (We) rt on day of Mardi, 20_
I (We) occupied as our principal place of resid the following described real property for whidh a Homestead Pip ty it is hereby claimed:
0 1 (We) owned ❑ Are buyvg under contact OIBSON COUNTY AUDITOR
Have a benefiaal interest in the entity Ihat is liable for the property taxes on the property and that owns the property or is buying under a contact
CONTRACT: RECORDED
If Wying on ranbaM Fee Simple ownees name
fmmrdeYs dfon where mrtact is retarded Record number Page
..
.a .o..a
PROPERTY DESCRIPTION.': 1'!: Ir';h
:r r �, x...,.t p,� r,t::'
County
Tcrmsfdp
I hereby certify the above sfaternents are true, correct and cornlplete.
Tang district (toy,
Sire of
(nw ben and street cib: scum, ZLP node)
^^Pa1rc-el munbe?r 1_
Q.Ly- IJ -JW -(�
Legal description
"moo
Is the papany in question:
papery
❑ Mobile Horne (LC- 6.1.1 -7)
If arty portion of the residerhtial stnc4se or the land not eheceedng one (1) acre OW ommdaWy amouhds tat sducture is used to Produce inoame. d scuba the use and portion
at the property utilized to produce borne.
..,:
.': •� _ ,. '' ' 'PROPERTY OWNED BK CLADdANT d OTHER COUMIES -
County
Township
HOMESTEAD
County
Township
I hereby certify the above sfaternents are true, correct and cornlplete.
. AT, 100X OFTiV
Sire of
(nw ben and street cib: scum, ZLP node)
4.
JC
-.a
f ..i .. .kF.... .
'.
ASSESSOR USE ONLY,...,
TM TRIIE.TAX.'
ASSESSED VALUE
HOMESTEAD
` NONatES1DENTAL'� g .
x a
^ VALUE: �'
. AT, 100X OFTiV
-. VALUE
tx le VALUE �a r
4.
-.a
f ..i .. .kF.... .
Land not exceeding 1 (one) ace irmhediately
a r`y` ' I - a` f +t, ✓p� j'
surrounding residential lmprovenhents-
Other land
2
. fi' •; �:'
Tdal land (Ithe 1 pOrs Ere 2)
(3)
(4) (4)
'p ` 7hy.H'TStir.,n,e�•+'Y�nrYer:2
z
Residential irnprovernents or Annually
.
t? 1..t',"w,YZt .fw,8. �j30,
Garage
(5)
'kr'?n, •"��nY
�.f..'�il'•'�at Srt!`.+fy�t'�y'�x
Assessed Mobile / Manufactured Hortne
71..3 7
Other 'm povements
(6)
-
Trial improvements (rrhe 4 through One 6)
(7)
Trial value (litre 3 plus One 7)
(6)
1 hereby ow* Me above is true, mrer3, and
complete.
Signature of Assessor
Dam sighed
Veriying action - Sigabae of Audmr
Dam signed
STANDARODEDIICTHM ALLOWANCE.
20 _ Pay 2O _
Lesser of 12 Homestead
Valuation or (35.000
f
Srgnatiae
Date - V 4
A (I