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STATE FORM 515M OW I.10) TR ASLRER FORM TS-IA
APPROVED BY STATE BOARD OF KLTLLVTS,LM PRESCRIBED BY THE DEPARTMENT OF LAICAL GOVERNMENT FTNAVLE IC 61,1-:32.1
- Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial,there s more incentive than ever for homestead fraud.Homestead fraud causes 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
• F I L E I� 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 Deparvnent of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
MAY 4 2011 Taxpayer Name . Location Address
C. .n Bean, Wendell J Jr/Angela D
8909 E 550 S
GIBSON COUNTY AUDITOR
OAKLAND CITY IN 47660
2846
Wendell J Jr/Angela D Bean Jr. Ill loll 001110101101110 1110(1110101101101101111.111011011111.011011.III!Ill lit
8909E550S
Oakland City IN 47660-8579
tIIIItIIIIIII'I111II1lii 'I"11111i1"1II'li liil'l 'I'll'1ll'I State Parcel Number / Legal Description
26-20-1000-000.193-00]/ PT NW 10391 AC 0-8
--
i
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
( PART 2: TAXPAYER INFORMATION -
Os _ l First Middle Last
Ar elq Daum (dean
Mailing Address(n and street,city,state,and ZIP code) same as property address
NOG( 55D S p�,klc�r� CAR/ I I�l �t1(�t�° ff��
_
Spouse Firstl • Middle - Last
Mailing Address i and soce4 city:state:and ZIP-code) - -Er Same as properly address : , - ' ,- ---
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below) -
I 1 1 l I I I I ' I s. •
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 fmancial penalties. -
Owner I Signature Si 1� Date
PART 4: ADDITIONAL INFORMATION - .
a U� E IiMI '"nhjwinliTinenrlitlifiralA &aSaniivikenra P►1t -
1211 F JIM
L 1
?-Have r "ve) �,_� ICI xCLI.Q,f certify that o�1��11Y MTTa�/(1]pp
:) occupied as our principa lace o. ,esidence the Awing described real property for which a Homestead Property Tax C hJ�Ait[iy`c armed:
l(We)owned ❑ Are buying under contract _
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.
If buying on contract, Fee Simple owner's name - -
Recorder's office where contract is recorded Record number Page
PROPERTY DES ION
CLAIM FOR HOMESTEAD PROPERTY TAX
,C IE
CREDIPSTANDARD
.,
_DEDUCTION
State Form 5473 (R215-92)
riG
INSTRUCTIONS: See reverse side for filing instructions,
1211 F JIM
L 1
?-Have r "ve) �,_� ICI xCLI.Q,f certify that o�1��11Y MTTa�/(1]pp
:) occupied as our principa lace o. ,esidence the Awing described real property for which a Homestead Property Tax C hJ�Ait[iy`c armed:
l(We)owned ❑ Are buying under contract _
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.
If buying on contract, Fee Simple owner's name - -
Recorder's office where contract is recorded Record number Page
PROPERTY DES ION
County
To ship
Xing d'
tot (city, town, township)
�eby certify the above statements are true, correct and complete.
Si n ure of claim m
Add �es (number and street, city. stateQZlPCOde) '7�
C% \b
Parcel number 1
-193
Legal Lion -
- aorac .
It any portion of the residential structure or the land not exceeding one (t) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
z - ao �a- /�o -G60. /93
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
�eby certify the above statements are true, correct and complete.
Si n ure of claim m
Add �es (number and street, city. stateQZlPCOde) '7�
C% \b
ASSESSOR USE ONLY
TRUE TAX
VALUE
� ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(t)
Valuation or $2,000
Signature of Audit r
Other land
(2)
Total land (line i 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 plus line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
®tying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE "
19 _Pay 19_
-
Lesser of 1/2 Homestead
S
Valuation or $2,000
Signature of Audit r
Date signed