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Homestead_Kolb STATE FORM 53569(R25-09) TREASURER FORM TS-IA I APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1 22-8.1 I'MI'O ' AN NO IC 'IK HOMI •S A D " OI ' Y OWN 'RS • _.t- 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 'auses 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 I; PRO PER 1 INFO RMA1 Timmer Name Property Address State Parcel Number Lepl Description: Bradley J Kolb/Teresa E 775 EAST 26-06-21-100-003.084-017 PT NW 21 1 9 7.09 AC Smith FRANCISCO IN 47649 C-I Complete and return to: 1110 1110110111MOMMOMINUM Iii HIMm®m®® GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 / PARTT likgP INFORMATION 4/ Owner 1 Fist vp�-.t�' •ppg� '$�tl Middle last Mating Address(number end sweet r�lY,state end ZIP cede) h I ■ E tl .�Same as Taor,eru address Social Security Number(lasts Waits) Drivels license,'" :DI •y ::•s digits) I I I I Other(Please speedy in Part 4 tetrad 05.,.,:r 1 First Middle /� Last J/LC1_.�•1 ,, GIBSON COUNTY AUDITOR L Mailing A ( q Sd street c.ty,state,and ZIP code) ©.6ame as property address 1 1ln Y-Y0--1(\€14/50.72" Mailing Address(Number and street,city,state,and ZIP code) 9 Same as property address Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below) , I I I I I I I I I Sum PART 3: CERTIFICATION 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. PART 4: ADDITIONAL INFORMATION mss. "r` CLAIM FOR HOMESTEAD PROPERTY TAX a CREDIT /STANDARD DEDUCTION I. State Form 5473 (R2/5-92) INSTRUCTIONS: See reverse side for filing instructions. FORM HC10 YEAR ERTIFICATION STATE NT ` I (We) e a that on the 1 st day of March, 19_ I (We) ocou fed as our principal T6 of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed: Zll'(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. CONTRACT RECORDED It buying on contract, Fee Simple owners name Recorders office where contract is recorded - Record number Page PROPERTY DESCRIPTION County Townshp Taxing district (pry town, Ship) arcel nu be =030`3 _0 al description Min I 0 ^000 (;eesc If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is ysed to prlodduce incol rib e the use and ponbn of the property utilized to produce income. /� ' COU1 TY 4101TOR PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES County Township County Township i lure of claimant ereby certify the above statements are true, correct and complete. i Address (number and street, city, state, ZIP e) e/ ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON - RESIDENTIAL VALUE VALUE VALUE VALUE Land not exceeding 1 (one) acre immediately (1) surrounding residential improvements. Otherland (2) Total land (line I plus line 2) (3) Dwelling (4) Residential improvements Garage (5) Other improvements (6) Total improvements (line 4 through line 6) (7) Total value (line 3 plus line 7) (8) I hereby certify the above is true, correct, and Signature of Assesor Date signed complete. venfying action - Signature of Auditor Date signed STANDARD DEDUCTION ALLOWANCE 19_ Pay 19 Lesser of 1/2 Homestead 3 - Valuation or $2,000 Signature of Auditor Date signed