Homestead_Cochran STATE FORM 53569(RIB-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1 22-B.I
IMPORTANT NOTICE TO-HOMESTEAD-PROPERTY OWNERS •
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
Oauses 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.
PART': PROPERTY •"FORMATION
Tamaver Name Property Address State Parcel Number Legal Description:
501 W ELM ST 26-18-36-404-000.498-009 WEST HAVEN I
HAUBSTADT IN 47639
Complete and return to: J®110f1Ml i7II i I B1111111111 mmmu
m ion
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
Middle . . — _ . . - last
(`n G-c 1 Eli u(�c I� Lock ra c )
Mailing Address(number and street,city,state and ZIP code) I ill same as property address
50 l Lit 54- I si t:- I-LJhs� -1- ,J V, & >q
•
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
PART 4:ADDITIONAL INFORMATION -
NOV 7 2012
•
GIBSON COUNTY AUDITOR
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10 ��
State Form 5473 (R2 / 5 -92)
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INSTRUCTIONS: See reverse side for filing instructions. " ,'
YV1
CERTIFICATION STATEMENT
�[�1� "V'' 9=9
.1 (We) I f / t- (/L(1' - IiIIC�►1 it q, certify that oFPt#e ist d y ot, armh, 19
'e) occupied pJ�1al`(p�lac�of re en1ce� the following described real property for which a Homestead P([�o'pert y,T�ax Credit is hereby claimed:
I(We)owned ❑�TreEBupng tr cbnilact `� ✓{ ,�
AllbDIT``d"
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is uyln at a contract.
CONTRACT RECORDED
It buying on contract. Fee Simple owner's name
Recomees office where contract is recorded Record number Page
- PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township)
Parcel number
® 3- -ov
Legal description
It 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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County Township
reby certify the above statements are true, correct and complete.
Sig ature of cI Y' antant- ,^
/%%W ""x�' �'""��
Address (number and street dry. state, ZIP code) /-h
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL.
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
Signature of Auditor
c3 VY)
Otherland
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pUs line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
i^9 action - Signature of Auditor
Date signed
- STANDARD DEDUCTION ALLOWANCE -
19_ Pay 19_
Lesser of 1/2 Homestead
S
Valuation or $2,000
Signature of Auditor
c3 VY)
Date signetl