Homestead_Schafer STATE FORM 53569(R2BO9) TREASURER FORM TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE ICS-I.1.22-5.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
IudiViduals 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
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.
PAR I: PROPER V INFORMATION
"la paeer Name Property Address State Parcel Number Leal Description:
Patricia Schafer Trust 0 CR ISO S 2614-20-100-000.882-006 PT NW 20-2-8 12.35 AC
OAKLAND CITY IN 47660 C-I /�
Complete and return to: I®hIDD]DODIDiNIQVDIMMIQDDUM II m0®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2: TAXPAYER INFORMATION -
Owner I First Middle Last
Mailing Address(number and Wee!,city,state and ZIP code)
Same as property address
Soda)Socially Number(last 5 digits) Drivels License State ID Number(last 5 digits) sae Other(please specify in Pan 4 below)
___ _ _ _ 1_ 1 1 _I__ — _ ._ _______�__. �r�
Owner I ,,��JJ First --Last-
R4re/eiA .574/AF T/Pus�l
Mailing Address(number and street,city,state,and ZIP code) Same as property address
/2 in f,/so A. OAKt/9 N v Cry , _II 3474S a
.
Spouse First)L • Middle Last
•
. Mailing Address(Number and street,city,state,and ZIP code) . , O Same as property address
•Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
1 1 1 1 I Sr.s
PART 3: 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
4 unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owgeril/g Date
FORM HC 10 1979
hewioed By Slate Board of Tax Commissioners
M AIM FOR HOMFCTFAO PRf1PFRTY TAX r.RFOIT FOR YFAR 19 79
To Be Filed in Duplicate'
J
(We)
March, 1941— I, (We) occu
which a Homestead Property
Tax Credit is-hereby being claimed:
I, (We) C& owned
❑ are buying under contract .
❑ have a beneficial interest in the
Property Description i
Taxing District (City, Town, Township): L
Parcel Number
If buying on contract: Owners name 0- r,im01e
certify that on the 1st day of
the following described real property for
�° «J Township
i I
or legal description shown on tax statement:
Q�t. %iUJ %l 41,3S-a_,C -
Contract recorded in Recorders Office - Record
e
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:
hereby certify the above statement is true, correct and complete
t /9
County Township
Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1
(one) immediately
surrounding residential
impro et
Other Land
Total Land
Residential Improvements
Other Improvements
_ N 18 1979
Dwelling
G
AUDI�IOR
T I Improvements - Line (6) plus (7) equals (8)
Ieby certify thglabove is true.,,correct. and complete.
Signature of Assessor
True Cash
`Value
(2) 1760
(3)
(4) a SAS o
(5) 0
(6) D
(7)
(8) 2 0
- ACTION BY AUDITOR -
'�Z7& 60
Assessed Homestead
Valuation Valuation
�s :ice
21
Date
Date: —