Homestead_Dewus STATE FORM 53569(83/11-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC61.1 22-8.I
e 1 1-'IMPORTANTNOTICE TO'HOMESTEAD'$ROP,ERTY ,OWNERS
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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.
�: __PA' 1:'PROPER Y'INFORMA ,ION
Tasnaver Name Property Address State Parcel Number Ira!Description:
Adam W Des D�l a,�`r FIRST ST 26-04-25-103-000.132-020 COLEMAN ENLG 2
°1)../.61.V FIRST
IN 47666
Complete and return to: 101]IIEIIl!IIDIIIDII]FJ UIIIIIUII]II1DnffllE11ll!II III0IIII
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
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Owner 1 First Middle Last
cQQ csl -T7e Q S la ce I cir teal ks
Ma'ing Address(number and street.city,state and ZIP code)
Same as property address
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Other(please specify in Part 4 below)
'j' AI1V '«'PA' z3:,CER IFICA ION;- at • 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 I Date
L ! ;
• JAN 3 0 2013
GIBSON COUNTY AUDITOR
s
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION
J State Form 5473 (De Department
Prescribed by the Department d Local Government Finance tg
INSTRUCTIONS: See reverse side for filing instruclions,
f r
I (We) certify CiLon the 1s�t L�'�y of March, 20
I (We) occupied as our principal place of residence the following described real property for which a Homestead P.rop�rtyv �C , -11 efeLy6`�atmea
❑ I (We) owned ❑ Are buying under contract
hi
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.
ONTRACT:RECORDEO' '°=-
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
County
Tmnship
I hereby certify the above statements are true, correct and complete.
�re�Yr / a /�l�r�J� IX aP�%(LJLffL
' -yl, svASSESS'OR E ONLY -}�
`
oNP, R0PERT.Y,6ESCRIPTI Vke'x -`
County
Ta ship
'°' NON;RESO)ENTIAL
Testing is (city, wn,
-,2 ,VALUE 1
_AT`700./AOFT,TV
VALUE
//wnnnshiP) N _
P I,q6 ber
L d
cr��ipvytif1onn
Is the property i question:
✓`�
surrounding residential improvements.
/// Ail/
Real property ❑Mobile Homo (LC. 6- 1.1 -7)
H any portion of the residential structure or the land not
of the property utilized to produce income.
exceeding one (1) acre 661 immediately surrounds that structure is used to produce income, describe the use and portion
County
Tmnship
I hereby certify the above statements are true, correct and complete.
�re�Yr / a /�l�r�J� IX aP�%(LJLffL
' -yl, svASSESS'OR E ONLY -}�
`
UETAX,.t� `
ASSESSEDVALUE
yHOMESTEAD't
'°' NON;RESO)ENTIAL
•, flo ,yli r �,.-
-,2 ,VALUE 1
_AT`700./AOFT,TV
VALUE
^a VALUE i
Land not exceeding 1 one acre immediately
surrounding residential improvements.
Other land
(2)
ON
^n ;i
Total land (line I plus line 2)
(3)
Dwelling
(q)
Residential improvements or Annually
Yom'.Y�G4
Assessed Mobile / Manufactured Home
Gars 9 a
( 5 )
�,. 1
A i
Other improvements
(6)
;yip -_ ;3 a
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
hereby certify the above is true, coned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20
Lesser of 1r2 Homestead
valuation or 535.000
Signature of Auditor
5