Homestead_Ross SIOTE FORM!3Hltirt'l•1 TREASURER FORM TS-IA
APPROVED BY STATE BOMPDOW MTTI'.\TS.9.w 'MIAOW°BY PIE DEPARTMENT OF MCA' GOVERNMENT FNACCE
Gibson County Auditor I IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
.101 N Main
'PRINCETON IN 47670 Individuals and married couple,are limited to one home,aead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive stun e'er 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 pnwide additional identifying information nemsan'to allow county government to better monitor homestead
fling. this information will be kept confidential and can only he accessed by authorized county officials.The Department of
Local Government Finance will me this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Ross, Boyd/Connie a15 22 Ems .
"It-t-mreefrfrrs
Oakland City IN 47660
4286
Boyd/Connie Ross
11322E Base Rd State Parcel Number Legal Description
Oakland City IN 47660-8470
26-13-12-200-000.832-006 SE NE 12298.5776 AC C-1
I tltl'Ittl'tlltrrllttll trrltrltrltl lltllll'IIII11.1.11.1111.1l
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
ty .— Xv Ss
-
�Ig Address(numrbcr and street.city,state,and ZIP curie) ._ - _' Some ns property eddies."' ' -- --
/ 3 RQ,,
Spouse arAnt First Middle Last
A
Mailing Address(Number and street,city.state,and ZIP code) l f 4Sme as prepeny address
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 Date
__.
;OR
M HC 10 1979 To i�e r'ilaa in C)U�,,11Carc
?rescribed -By State Board of Tax Camissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT TOR YEAR 19_ '
SEE BACK FOR FILING INSTRUCTIONS I` C
�� � � � 003 - oo�`�a_ o
3,
�� �"�� �, certify that on the lst day of
M 19 I, (F7e occ�ied%as our'principal place of residence the following described real
property for which a Homestead .Property Tax Credit is hereby -being claimed:
I, (We) [7 caned 6e -�� —off ��J QG�a
❑ are buying under contract
Q have a.beneficial inte_rest.in.the taxpayer ,
y /pJ
Property Description in County - -tc - =� ' Township
Taxing District (City, Town, Township):
Parcel Ihunber or legal /description shown on tax statement 976
i If buvina on contract: Owners name (fee simple owner) µ
Contract recorded in Recorder's Office - ..Record No..` Page
If 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
Any other counties in which individual owns or is buying real property _ :Coon :Ibcanshio
I heiahy.certify the above statement is true, correct and complete.
:- *Signature 2 •r:.Street Address - a v -.:City,. State and Zip Code
*Individual either owns or is buying uner a contract-that provides he is to pay the
_
_taxes on the, residence, or has a beneficial'.. interest in the .taxpayer.
- FOR ASSESSORrS USE'ONLY
.'' ..True Cash Assessed - Homestead It
Value Valuation Valuation
Zand not exoeedirxJ 1 (one) acre irranediately ,. -- •:.,:; 30 0:.',
7.
surrounding residential improvements
Other Land . -._:�- '• . .... (2):
Total Land
Residential.-Improvements
Dwellinq
Garage
Total
other Improvements
Improvements - _Line (6) plus (7) equals
by certify the above is true,`correct,
g0sor
l
(3)
(4)
W4 0 ///// a
_ ACTION BY AUDITOR