Homestead_Riley (3) STATE FORM 53569 DU/S-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,22E09 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1 22-8.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS is
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
seduction 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•
Taxpayer Name Property Address Slate Parcel Number J.real Description: ,
Adam C Riley 11553 E 150 S 26-14-19-200-000.880-006 PT NE 19-2-8.77 AC C-I
OAKLAND CITY IN 47660
Complete and return to: 11111110MIIMUMUIIDIO1111111111MEIDIElnill
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
j PART 2:TAXPAYER INFORMATION
Owner 1 First Middle Last
Ai)A„I G //',rr Ts /?, 'L v
Mailing Address(number and street wry,state and ZIP code) I/Sarrre as property address
Spouse First Middle Last
Medina Address(number and street city,state and ZIP code) Seine as property address
Social Security Number(last S digits) Drivers License/State ID Number(last 5 digits) State Other(please soeafy in Pan a below)
:._I. _I e PART.3••CERTI F.I ATION
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
( )
PART,4: ADDITIONA ,INFORMATION.::: ....;:;
FILE '�-
• DEC 2 S ZUI[
•
01060N Cnt1NTY AUDITOR
J
CLAIM FOR HOMESTEAD PROPERTY TAX � FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
Stets Fond 5173 ( De
Prescribed by the Department of Local Government Forance
INSTRUCTIONS: See mttmse athio for lstp iWuctions
I (We) L ! (C9' certify that the //1ltday of March, 20_
1 (We) occupied as our principal place of residence th lot .ng described real property for which a Homestead Weltr,Ta1YCrr( is hereby ciaimed:
❑ I (We) owned ❑ Are buying under contract GIBSON COUNTY AUDITOR
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.
ONTRACTRECORDEDs^�'rc. `�-a?; gc5"Y - '..y'i'''.'�•E� '�`R•�",
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Record number Page
�".':.?P.ROPERT.Y: DESCRIPTION ^r `.'r`- ?"'a"'..:- %vn.
_r'r`':§'`.iF..;. - ')a�3_'L'4y,,
County
Tomship
Taxing district (city, town, township)
U /C-
Addre (number and street, city, state, ZIP code)
3 /30 3
Parcenu� r
Le 1 es d
'o /1..
Is the pro rty i uestion:
O
' '"NO -RN ESIDENTIAL
t
YY o ^
Real property ❑ Mobile Home ( /.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that stfu=ro is used to produce income. describe the use and portion
of the property utilized to produce income.
me) —e06
ONE RTY, OWNED; BY :CL'AIMANT;IN'OTHER`COUNTIES,i
County
nship
County Toxnship
hereby certify the above statements are true, correct and complete.
Signet a of claimant
Addre (number and street, city, state, ZIP code)
3 /30 3
x �•� '""F?%AS.4ESSOR USE ONLY
: -TRUETAX���
ASSESSED VALUE
HOMESTEAD'
' '"NO -RN ESIDENTIAL
t
-1a :a'a�s`Srr ?:,n.
W,LVAI:UE,a.`Trt.�a
'e�-,
MATi10o %rOFTfv-
p :VALUE
� °VALUE -5R
:....1.a..,r.
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1),i"°t�``^P
✓_,=
Other land
(2)r,i
^-
Total land (line 1 plus line 2)
(3)
vg
Nig, -0-"
Dwelling
(4)
'Residential Improvements or Anntttl0y
i -$
,
Attsesxd Mobile I Manufactured Home
Garage
(5)
;
4i •_ iv
Other improvements
(6)
..>�»r-r;^ -•
Total improvements (line 4 through line 6)
(7)
Trial value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STAN DARD :DEDUCTION'ALCOWANCE'^,� „k
20 Pay 20_
Lesser of V2 Homestead
5
Valuation or 535.000
Signature of Auditor
Date signed