HomeMy WebLinkAboutHomestead_IngleCLAIM FOR HOMESTEAD PROPERTY TAX
{ CREDIT /STANDARD DEDUCTION
State Forth 5473 (R8/7-07)
Prescribed by the Department of Loral Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I(We)
I (We) occupied as our principal place of
x f
f
REM
ii
�-- certify that on the tat day of March, 20
real property for 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.
CONTRACT ••D
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
County
PROPERTY DESCRIPTION
Toirrrsmp Taxing district (city, town, township)
Parcel number
Legal desc' lion
Is property in question:
T �I
I
❑ Real property ❑ Mobile Home (IC 61.1 -7)
If any portion 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.
AZo'Dd- S9 -o 3a- no o. o y/ -O/9
Txrxnship
County
I hereby certify the above statements are true, correct and complete. \ signature of claimant (�
/11 iII -I- . I1 \/ /_
(number and sbael. cdI4 state. and Z /Pcode)
•• USE ONLY
s VALUE
I HOMESTEAD
• s
AT 100% OF TTV
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
_
Total land (fine 1 plus line 2)
(3)
[)welling
(4)
Residential improvements wMnuaity
-
Garage
::: =`: •, `. ". ; :, '
. ..
Assessed Mobile / Manufactured Home
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 phis hine 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed (month, day, year)
complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
20 _ pay 20
Lesser of 12
Homestead Valuation
or
45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
44,000 for 2008 pay 2009 41,000 for 2011 pay 2012 5
43,000 for 2009 pay 2010 40,000 payable after 2012
Date signed (month, day, year)
STATE FORM$3569(Rig-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTNCENT OF LOCUM.GOVERNMENT FINANCE IC6-1.1-22-I.I
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS 7 -111
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
•luction becomes more beneficial, there is 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 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.
" .;je —7_ IT PROPERTY INFORMATION
Tatoaver Name Prdoerty Addrest State Parcel Number legal Description:
110 S MAIN ST
William H Ingle 11 26-02.59-032-000.041-019 OLD PLAN 3 PT BLR 6
HAZLETON IN 47640
Complete and return to: DIlh{UMMIDI Qml'lfl 01®®I1[UllhhII1lllu111l
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
•
• . • PART 2:TAXPAYER INFORMATION • 14'44';•••
Owner I First Middle Last
X : al AM x 1-16 441 ItJCLE
Mathrg Address(number and street,city,state and ZIP code)
Same as property address
Spouse First Middle last
Mailing Address(miter and street,dty,state and ZIP code) Same as property address
Social Security Number(last 5 digits) Diner's License/State ID Number(last S digits) sine Other(please specify in Pan 4 below)
• PART3: CERTIFICATION . `y
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. no Date
Spouse Signature Date Telephone
't- PART 4:ADDITIONAL INF,!)EMAPQN
• DEC 4 2012 /7
GIBSON COUNTY AUDITOR //