HomeMy WebLinkAboutHomestead_Lythgoe STATE FORM 51169(R2/149) • TREASURER FORM TS-IA
APPROVED BY STATE Boom CF ACC JNrS,NO9 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE K 6-1.1-n-S.I
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
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 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 indentifying 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: PROPERTY INFORMATION
Property Address(number and street,city,state,and ZIP code)
�a 1/ the `�i� J 17%o ,�
State Parcel Number
24 / 1 - /S - 3o2 - 000 f
•
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
frIPINCZJIM
Mailing Address(number and street,city,state,and ZIP code) , (3..—t. CA Same as propery address
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.
Owner I Signature Date
PART 4:ADDITIONAL INFORMATION
Ja1,/77s.eo/ .3 14 n C0-4/ Aye ., A x i
HT'#7
INSTRUCTIONS
CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
.,t:'�;' r,, FORM
STANDARD/SUPPLEMENTAL DEDUCTION
ati~x: State Fotm 5473(R13/12-09) HOW
` Prescribed by the Department of Local Government Finance '
INSTRUCTIONS:See reverse side for filing instructions.
n n rR=: -��.T�A.-�..rdi a 4t.'r:1 ys sly=$:^
-���'"'L7�' �', ; CERTIFICATION;STATEMENT�/a°ay3 e�e�aaat�L"tc�'e��t�..tJ.�,tnit�+�+sn�+�€g' `.e:�T:-
�. _M vUNrirevat r
certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the%owing (8 cribed 4 al property for which a Homestead Property Tax ndard D u ' n is reby claimed
under contract on the date this application is ed, (date of filing). I(We):
❑ Own ❑ Am(are)buying under recorded contract GIBSON COUNTY AUDITOR
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
t $ Wrr.:+�'*9���,z:�i. -trF�'�/Fy �"�' 'CL�MA-NTgSiINFORMATION'dr�i7�'tYCCa -4L1ril,� alifiWER -r_�..'ar
Name of claimant
yw�,#zrsc �m.,.��•^���+ a
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
a I-Ce:P , .w-3' h ,y-`q iZeli - P•ROPERTtYIDESC RIP.T eath5`us t kt;I .3F "2+ 3;
County F Township Taring district( town ship)
P�1mel nu /�/� I Uon Is�th-eyoropeM In Question:
.1�_���(g 3oa��V�/ �•� 7�(f.Real property ❑ Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately sunou s that structure is used to produce income,describe the use and portion
of the property utilized to produce Income.
-:L�-i?xlp, . ia.a,..,�.r-a',�?�;�tigVA` PROPERT,Y;OWNED 8_Y�CLAIMANT:IN;OTHER,COUNTIESy03:34: gtagg,,.x -rte,-qiWa
County Township County Township
I hereby certify the above statements are true,correct and complete. S=cure of riot nt r, 4717%--t_
less(numbe+ M street,city,state, Sl
ZIP code) 17 i II 0
gA r-a, ASSESSOR USE:_viri ki,alTRUETAX VAL` �i4ASSE SSED F_T it-ix HOMESTEADL �'". �*�S>NON RESIDENTIAL' t.
.-y i.._ S19R.,_,,Y,, .14.l rl;a . . 'II`tATc100%5OF T.T,Va'vT[`. :tiVAL`•11E.+3 w4. sx s�z+ VAL'UE x- �}-•.t:.
Land not exceeding 1(one)acre Immediately (1) _ �
+ .' *9-,57-;:::::-.
-
surrounding residential improvements. -'
2C 1:
Other land (2)
Total land(line I plus line 2) (3)
Dwelling (4) n- Ys �.•- 'x ti
Residential Improvements or Annually
Assessed Mobile I Manufactured Home Garage (5) '- , ; ' - -.`.. -.• .e .
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, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
.a„t l ,. LL"' mot`" r STANDARD DEDUCTION LA LOWANCE_-yam ,y ,a3''"yy 7 "Y.{+ g-Fia, t 3 R
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductions provided in IC 61.1-12 to a mobile home that is $
not assessed as real property or to a manufactured home that is not assessed as real property may not exceed
one-ha 12 of the assessed value o 1 :mobile horn:or manufactured home.
Sigrstu f di I P Date sign inflh,Vie q