Homestead_Davis (2) STATE FORM 53569(R2/5-09) TREASURER FORM TS-IA I
APPROVED BY STATE BOARD OF ACCOUNTS.22009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 106-1.1-22-5.1
5 . -- I Nit 'O '9 AN NO I • 11/0 HONE SI Al ' ' O ' . '4 YOWN I
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
de uction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
uses 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.
- PAR I:,PROPER Y INFORMA• ION .. '
Taxpayer Name Property Address State Parcel Number Leal Description: '
STOFFEL RD/BUCKSKIN Davis 26-20-28-200-001.872-001 / PT NE NE 28-3-9 1.00 AC
ELBERFELD IN 47613 v
9
Complete and return to: 11111111QDI11111111111QE1Q1®mIMIO®HIllallE®
-GIBSONCOUNTY"AUDITOR101 N MAINPRINCETON IN 47670
- PARTS3T'AXPAOIXIINFORMATION - - - '.'
Owned First �,D Middle . Last
e.yp Matting-address((number and street,ciQ,state and ZIP code) (yam r� (\��
Same as Y r 1 DO l__I' y- _/l Yy 0 O C�`� 4��nY address
Mailing Address(number and street,city,state and ZIP vide) as property address
Social Security Number(last 5 digits) Drivers License State ID Number(last 5 digits) Sate Other(please specify in Pert 4 below)
- -.' . [t�p�CE•t IFICAt ,ION .,, ;.
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
( )
- _ PARTG3ADDITIONAL INFORMATION ' '. - • •• --
FILED
MAY 5 2011
cm
(aWSON COUNTY AUDITOR
CLAIM FOR HOMESTEAD PROPERTY TAX F;7FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
Store Form 54-n M7 / 5-M I
P INSTRUCTIONS., See reverse side for Ring instructions.
"FILT
rescribed by the Department cd Local Government I�inanoa
T. cERTiFicAmm sTATFmEwr--1
[77�
N'
4 I(We)—a J ja-�'Wn cerfrfv that on the . 1 stfty of MI
I (W pied as our principal place of residence the Mowing described real properly for which a Homestead Property Tax G&al � reby
) owned ❑ Are buying under contract GIBSON COUNTY AUDITOR
Hawn 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 conblact.
coNTPAcTFtEcofwED,'
If buying on contract Fee Simple ownses name
Recorder's oboe where contradis.. Record number Page
PROPERTY [)ESCMpq6W�. 'r.',
'WNW", kL4
County
County
ToNnship
ta I -W
I hereby car* the above statements are true, correct and complete.
Parcel r%ffnber
Legal deamption
Is the propeW.
question:
Valuation or $35,000
Wees (number and street dly, slate, ZJP code)
WF KE R a - T cT /4a,.
I
C9490 PW"
❑ Mobile Herne (LC. 6-1.1-7)
If any portion of the residential structure or the lard rKA exceeding one (1) acre that rn"mcfatety sunounds
is used be
produce inoxxne. dent be the use and portion
of the Mop" Wilisad to Woducx,
a�ao -ag- sod- cVl.g7a -oa 06-cV I
,,PROPERT.Y OWNED BY CLAWAINT KO HER COUNTIEW,
'WNW", kL4
County
Toornship
County
Township
I hereby car* the above statements are true, correct and complete.
d claunard
N�AA.0
m
M (A YLC-
Valuation or $35,000
Wees (number and street dly, slate, ZJP code)
-,,"'STMDAFWDEI)tJCTNMALLC)VMCF�";t,'.;
TRUE TAX
ASSESSED VALUE
!'HOWS71EAD
1
Lesser of 12 Homestead
m
Valuation or $35,000
Solature of fiucutw
Land not exceeding I (one) am i mmadiataly,
Oats signed
surrounding residential improvements.
Other land
(2)
Tdaf land (Im I phis fine 2)
(3)
'g -Z n
j k'�
Dwells rig
(4)
Residential krprovef,entsorAnmLedty
Assessed Mobile I ktrusfactured Home
Garage
5
z, f 7 ;r.'qe
()
M
Other improvements
(6)
0
Tdal irnprovements (line 4 through fine 6)
(7)
Total value (fare 3 ph& fine 7)
(8)
I hereby certify the above is true, correct, and
comPiete.
Sonabse of Aseasser
Data signed
%AwtWg action - Signature of ALxftw
Date signed
-,,"'STMDAFWDEI)tJCTNMALLC)VMCF�";t,'.;
20— Pay 2O_
Lesser of 12 Homestead
Valuation or $35,000
Solature of fiucutw
Oats signed