Homestead_Tooley (2) STATE FORM 5)569(R3M-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2079 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1 1-22-8 I
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Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
4 nduction 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.
c' ' yst:PAR111: PROPER Y,INFORMA 'ION.::::147" .11.T'r i,' ..i:
iamb er Name prooert.Address Stale Parcel Number Len(Description:
Nathan Tooley CR 1225 E 26-14-18-204-001A51-006 PT SE NE 1822 2.42 AC
OAKLAND CITY IN 47660
Complete and return to: IMIIMI.11111111DIEDMIDIIIIIMBIUMEIMIEME
GIBSON COUNTY AUDITOR. 101 N MAIN PRINCETON IN 47670
':=114.4.3)WWWILWRTZFATP7A17=PORICITTION`",' '::" ' H . ' '.',,:. -C e ':' ''' •i
Owner 1 First Middle Last
itiott Aar /3 Ast p-■
Mailing Address(number and street.csty,state and ZIP code)
17.71--9arbEis—properly address
1 I
aid„," 6„7-x 1/4b. if 7‘7. o
spouse First Middle Last
Mailing Address(number and street.city,state and ZIP code) Same as property address
Social Security Number(last 5 digits) Onsets License/State ID Number(last 5 digits) Stale Other(please speedy in Part 4 DelOW)
' ':'; .f W7jart•!'%106,30113.11VATIM.I.PPITIYICATIQN • a'''' ••• : ''... . •'I:'•a - '• 1• ' ••:C. 4-
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
I
FILED.
APR 1 :12013
GIBSOlialiErN LUU fY AUDITOR
k\
I./Irl (Mwe)l
i
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5173 (Re 14-03)
Prescribed by the Department of Local (33ovemmem Finance
INSTRUC77ONS. See reverse ddb Ibr /ring /rmaurionm
e) occupied as our principal place of residence the follol0 descr
(We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property
FORM YEAR
HC10
FILES
certify that on the 1 st day of March, 20_
real property for which a Homestead'PiopertyLTexs'Gredit is hereby claimed:
GIBSON COUNTY AUDITOR
s on the property and that owns the property or is buying under a contract.
'} �a' aftuiyra >4ir_'�'"�r- �tCONTRACTiRE_ CORDED" s�, a,= i' tN ''y:,.-- r`:3'Fr.w",3�YgYL"t',:
If buying on contract, Fee Simple owners name -
Recorders office where contract is recorded Record number Page
°•;. 9;, s3?J_- c''u- Y,ir'.,._- ''`?ff:it.
County
Township
T Irict (dry, town township)
Parcel M �� /�_�
L�9 �scnpuon
�f/
is the vmperNinquestion:
111
I — —
eel property ❑ Mobile Homo Q.C. 8-1J -7)
H 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 ublized to produce income. �. ��z
#a6 -/, a�s/-cn /. �� / -cy,
INS i' S SSO USE ONLY �
County
Township
County Township
hereby certify the above statements are true, correct and complete.
ature o ima I
✓�/
Oddress (number and street city, state, ZIP carte)
�AT.1100 %'OFTTV
INS i' S SSO USE ONLY �
i. TRUETAX' .ASSESSED
VALl1E
aHOMESTEAD�I
—i. i` tNOWRESIDENTIAL F�%+
�l
;yy�rYALUE�af'}),
�AT.1100 %'OFTTV
f1yVALUE?;�r41'�'„VALUEJ'?r
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
j 3Y'r `?.•r
Other land
(2)
% 0rY.`�Q
-
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
s`- r r, a-
�^K a s,, ysrsrzcr
1*..9w'`.d �'
Residential Improvements or Annualty
* saxGL•6
Assessed Mllble /MaurfatAUed Hans
Garage
5
Other improvements
(6)
• •-n_j y_ -3G{�
t��'`fs
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(S)
I hereby certify the above is We, coved, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20_Pay 20_
Lesser of 1A2 Homestead 5
Valuation or 535.000
Signature of Auditor Dale signed