Homestead_Thorne STATE FORMT3569(R3/5.l0) URER FORM TS-IA
APPROVEDBY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARThIEN'T OF LOCAL CAVE 20.TENT FINANCE IC6-I.I23.s.1
e IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
d 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 theysare 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 crate tools that will help county officials-eliminate
homestead fraud.
PAR I: P'OPER Y INFORMA ION ?"?: , g
Tesuaver Name - Property Address State Parcel Number Leal Description:
Laura A Thome 1827 S 1200 E, - 26-14-19-104-000.542-006 CAPT MCCULLOUGH 4PT C-I
' OAKLAND CITY IN 47660
•
Complete and return to: - - ICI]lltlU!IAI[IlnuMUIIIItMPOM1f91f.'1II711
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
' ' ' "' - , i'h SPART 2: TAXPAYER INFORMATION...A` 4 r' si'
Owner I First Middle Last
w ins. Anne M ov r is
Mailing Address(,umber and steel oty,state and ZIP code) Same as properly address-
52 --) S / Loo E. Ctic.(cvnd Ci f/ /AP-i7&&o
Spouse J h h First ' Middle — - -� Last
. I 1 - Tlicoxs N S
Mailing Address(number and street,city,state and ZIP code) - fame as property address
r "'?Ida
Each'ndersigned certifies,under penalty of perjury,that the above and tdregoing information is true and correct and that no or sheis eligible to receive the I
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 Signature y vi, Date
,
IT
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1
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R8/7-07)
•� au Prescribed by the Department of Loral Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (We) n u ,�,(,(%t-f-c ��`�"��. 1 " certify that or &A slid* ojDUO • p-
c
I (We) occupied as our principal place of residence the follovring described real property for which a Homestead Properrt�ty -yyT,ax Credit is hereby claimed:
'I (We) owned ❑ Are buying under contract p�(� �
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the RfQ@Wtt utfder a contract.
Allnmr -
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Township I Taxing district (city, town,
Record number I Page
I ��Iuq-1'7-4 �• � Legal tlescripgon Its the propeny'mRea won: ( 7)
jU�GI, property ❑ Mobile Home /C 6 -1.1-
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that
of the property utilized to produce income.
0,63/a -�G�
used to produce income, describe the use and portion
20 pay 20
Lesser of lt2
Homestead Valuation
or —
45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
44,000 for 2008 pay 2009 41.000 for 2011 pay 2012
43,000 for 2009 pay 2010 40,000 payable after 2012
Land not exceeding 1 (one) acre immediately
surrounding residential improvements. (1)
•.r' -,.,•�
Other lard
(2)....
Total land (line 1 plus fine 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
*'
Garage
(5)
Other improvements
(6)
- -
Total improvements (line 4 through line 6)
(7)
Trial value (line 3 pits fine 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed (month, day. year)
complete.
Va prig action - Signature of Auditor
Date signed (month, day year)
20 pay 20
Lesser of lt2
Homestead Valuation
or —
45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
44,000 for 2008 pay 2009 41.000 for 2011 pay 2012
43,000 for 2009 pay 2010 40,000 payable after 2012