Homestead_Pfeffer STATE FORM 53569 DUO-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-8.1
IMPORTANT NOTICE TO HOMESTEAD'PROPERTY OWNERS. �. V
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
uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
s ]dard 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.
PA a I: PROPERTY.INFORMA ION • .
'It-Name Property Address Slate Parcel Number Leeal Description:
John S/Melody K PfetTer 115 S FOURTH AVE 26-19-31-304-000.477-009 E PARK ADD 443
HAUBSTADT IN 47639
Complete and return to: I®IIDD]I11111E1 fllD9mIII HIDUIIJ�lmmm®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 IJ1WJ
4PART 2:TAXPAYER YE R I NF ORMATION
,
Owner, F Middle Last
S i-e v e n PFe -We r
Mailing Address(number and street,city,state and ZIP code) Same RupenY adtlress
PO C'�X ( 7B , < <5 LI fh Ave • daub �adfrr iN u763c
. _�
First esaae • Iasi d Oc y _ Pre-Ff-c r
Mailing Address(number and street.city.state and ZIP code) J Sarre as addr
PO of rel 8 , 115 U+h nye.• u b fa d t; 1 N `�7 6 39
'
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.
,( re Date
PART 4:ADDITIONAL INFORMATION .
•
i
•
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION HC10
State Form 5473 (11814-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions
I (We) -4'0 -'� 2 ' certify that on the 1 st day of March. 20_
1 (We) occu�pie,'I.").. #nci p.I 11f.11 residence � a4 'I a 'bed ..I pro 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.
V'W-.'toNTRAC 74, RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
OR
YW0
--DES-CRF-T101iI
FfdP, E IRTY R . . I . . . .
County Township
IHOMESTEAD.4
Taxin d
fact (01y, to
township)
Parcel number Legal description
eddreu (number and ;dy, sjIr cad)b
Is the props
in question:
6 11 �� — C)c)'Am -
I
K�aal property EDMobile Home (I.C. 61.1-7)
If any portion of the residential structure or the land not exceeding
one (1) acre that immediately surrounds that stndcturo
is used to produce income, describe the use and portion
of the property utilized to produce income-
. . . . . .
OR
YW0
County
Township
IHOMESTEAD.4
County Township
I hereby certify the above statements are true, correct and complete.
'VALUES*
Spa aims
,.,L
A 2 4LW�
eddreu (number and ;dy, sjIr cad)b
Ct
U
OR
YW0
ASSESSED VALUE ALU
E
IHOMESTEAD.4
NON E NT4 A L
W
I
'.
'VALUES*
!MT,100WO F TrvA
VALUE
L�4�U E- -
Land not exceeding I (one) acre immediately
(1)
surrounding residential improvements.
. . . . . .
"ZK —y
Other land
(2)
___% : am
Total land (line I plus line 2)
(3)
Dwelling
(4)
9'
Y
Residential Improvements or Annually
Assessed Mobile I Manutactured Home
Garage
"IN
(5)
'tR
Other improvements
(6)
A MME
Total improvements (line 4 through line 6)
(7)
Trial 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
20 — Pay 20_
Lesser of 112 Homestead
Vouatiort of 535.000
Signature
I