Homestead_Wilm (2) STATE FORM 53569(R3l&10) - TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2W9 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENTEINANCE IC6.1.1-22-S.1
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
d
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:
- PAR I: P'OPER -Y INFO'NIA ION -, . t .
Taxpayer Name Property Address State Parcel Number Legal Description:
Stanley R\Vilm 305\\'EL ST 26-19-31-303-000.213-009 ORIGINAL PLAN 168
HAUBSTADT IN 47639
I
Complete and return to: I I'II IIDU1D001ROf11IIi10 IIIIHIf11171111IIOflllIm�®®
GIBSON COUNTY AUDITOR, 101 N.MAIN PRINCETON IN 47670 LLn W1W 1w1 till
. PART 2:'I'AXPAl'ER INFORMATION
Used I First Middle /'i l I y�� Last
6/ I e J/ RA/ Ai .
Mailing Address(punter and street,city.slate and ZIP e) ly<game as property address
. - - -
Spouse - l‘i/� First . _ Middle Last
Mailing Address(muter and street,city,state and ZIP code) Sane as property address
Soda!Security Number(last 5 digits) Drivers License/State ID Number(last 5 digits) Sine Other(please specify in Part 4 below)
. L
PART 3:"CERI IFICATION 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.
Ovmer 1 Signature Date
( )
PART4:ADDITIONAL INFORMATION
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•
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CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDITISTANDARD DEDUCTION HC10
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
... 4.CERTIFICATION STATEMENV�-
I (We) certify that on st day arch, 20
T
I occupied as our principal p of residence the following described real property for which a Homestead ?Tax it is hereby claimed:
Z, (We) owned ❑ Are eying under contract GIBSON C&NTY AWITPH
aHave 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.
bUTRACT;RECORDED
If buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
'
t Ef jPROP ITY - :DESCRl1PTION
County
Township i
TW-
Mzz
ce��Iber
Le
L al ascription
Is the property in question:
My'- W-6f /2
r�' lz 9
1 VReal property ❑ M.N. Home (I.C. 6-1.1-7) .
If any portion of the residential swuXure or Ne Wad no x ing one (1) acre that immediately guffolindg that strirct ire Lg used to Produce income. describe the use and portion
of th"operty Utilized to produce income.
patao(-
R 6 IRERW OWN E [�B Y C a] WA NT-, I k bT Ii EK11160 NTI IE§ U.
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
' nature cla t
ress (number and street, city,
305 6'V71y' sr z a L,, is
7x ol-7L 6 3 7
'� ASSESSOR USE ONLY =
ASlig!�CE76VZk
6" iRSTEAD I
0- NON.RESIDENT
VALUES
VALUE
Land not exceeding 1 (me) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
011
1Residenrtial improvements or Annually
,
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
..set
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(a)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
mirfWNAN�� -" "i��AO—W�?T;STANDARD.'DEDUCTION"AL-L'OWANCE
20 _ Pay 20_
Lesser of 112 Homestead
Valuation or 535.000 $
Signature of Auditor Date signed