Homestead_Jost (3) STATE FORM 53569(R3/S-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FI".NCE IC6-1.1-22-8.1
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
0causes 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. -
PARTI: PROPERTY INFORMATION
Tawaser Name • Fromm'Address State Parcel Number Lent Description:
Terry&Nicole Jost 205 S WEST ST 26-18-36-404-000.292-009 PT SE 36-3-11 .65 AC
HAUBSTADT IN 47639
Complete and retunr to: 1111111111111111[111111110111101111111101111111[111111E111111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
- PART 2:'TAXPAYER FolkMATION::14 ' ,. ,:. _
Owner 1 First Middle Last
Tern / L cJO5T
Mama Addraks(number and street.city,state and ZIP=de) artw as property address
. - - . Middle Last
Mailing Address(number and creel,city,state and ZIP code) ti." a as property address
I
•
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
Led
1 I(_ ___- • 'PART..:ADD ITIONAL INFORMATION;__ ._T_, • _ _+ ,'._ _.,
_,_ ..d. F
•
. JUN 5 2012
C.J.
CID3ON COuN f Y AU ITOR
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION
HC10
State Form 5473 (R5110-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (We) certify that 0- .1 %dayof March-20
I (We) occupied principal place of residen th following described real prope for which a Homes Id jEa, "d
occupied p
❑
I (WV,) owned ❑ Are buying under cont ct
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is PfAlp upt, TWact.
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded
GIBSON
Record number I Page
TAN6ARD)DEDUCTIONIALLOWANCE
�r
'.KWM�:VM FROIRER . DESCRIPTION V�-'!!-
0 Y`W� .2 ry 7,4f' r qN
Court
TcVmshiP
Tacing district (city, tcxim, township)
Parcel
0 , P cel nSber
--D cc)
ption
It.
Is the property in question:
I ❑ Real property ❑ Mobile HMO (LC. 6-1.1-7)
If any pc4lim 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.
TAN6ARD)DEDUCTIONIALLOWANCE
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of cl a':
�<D IFA
(number and street, city, state, ZIP code) I I -
-, 1A)rT .5
S .S 7 14A L4A ,
TAN6ARD)DEDUCTIONIALLOWANCE
20 Pay 20
li�O—MEiT�EAji~
T VAL qE"
n MONAESIDE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Valuation or $6.000
P
Signature of AudiloP
�111-1 raz='�
V
Date CS
Other land
(2)
tag
Total land (line I plus line 2)
(3)
Dwelling
Residential improvements
(4)
Zv
Garage
(5 )
I ;
IN 0 It, I
W
Other improvements
(6)
uW;
N®R
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
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
TAN6ARD)DEDUCTIONIALLOWANCE
20 Pay 20
Lesser of 112 Homestead
Valuation or $6.000
P
Signature of AudiloP
�111-1 raz='�
V
Date CS
