Homestead_Sullivan SIAM FORM S)!Inta-t urvl MEASURER FORM TS-IA
RmEIMPORTANT NOTICE TO.HODIESTEADFP PROPERTY OWNERS.11Gibson County Auditor
101 N Main
PRINCETON IN 47670 Individuals 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 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 teethe the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filinyp.This information will be Lep confidential and can only be accessed by authorGed county officials.The 1lepanmem of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Sullivan, Colene H. Life Est Etal
RI Box 110
Monroe City IN 47557
169
Colene Sullivan
201 N 1150E State Parcel Number Legal Description
OAKLAND CITY IN 47660-8609
26-13-12-200-001.037-006 003-01037-00 PT SE NE 12-2-92AC
` C-1
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
CO ) e • hid Let ,Su ) ( ■ II0- N]
®i8 Address(numbs and>tieet,ciN,state,and2tY code) -- — - Same"as propertyixidtess
2o f N G/ So C oo. k to. a. CI4/ 7A/cdt'c ,secs 4 76,60
Spouse First Middle Last
Mailing Address(Number and street city.state,and ZIP code) Same as properly address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
see
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
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner 1 Signature e Date
CLAIM FOR HOMESTEAD PROPERTY TAX
r t CREDIT /STANDARD DEDUCTION
State Forth 5473 (R817 .07)
S •w ! Prescribed try the Department of Loral Government Finance
INSTRUCTIONS: See reverse side for filing instructions
F4"R YEAR
Hf
I (We) � 7 • - certify that on the 1st day of March, 20_
1 (We) occupied as our principal place of res' ence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Are buying under contract
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.
Parcel number Legal des y(pn / 2 —2 A �... I Is the property in question: 0 'E JJ LL. ❑ Real property ❑ Mobile Home (IC 6 -1.1-7)
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 td5zed to produce income.
a�-
13 -ia -goo- ooi. 037 -ooh
County Township County 7ovnshin
I hereby certify the above statements are true, correct and complete.
(number and street (ft state. and ZIP code)
Land not exceeding 1 (one) acre immediately (1i
surrounding residential improvements.
rr
-:•_° -
Other land
(2)
Total (and (line 1 plus fine 2)
(3)
Residential improvements or Annually
Assessed Mobile I ManufacWred Home
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed (month, day, year)
Verifying action - Signature of Auditor
Date signed (month, day year)
r
W7pay 20 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 112 44,000 for 2008 pay 2009 41,000 for 2011
Homestead Valuation pay 2012 b
or 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Audior Date signed (month, day, year)