Homestead_Goodman STATE FORM 53569(R 718-09) TREASURER FORM TS-I Al
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.I 22-B.I
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? INIPIRTANT NOTIGE TO HOMESTEAD PROPE RTY OWNERS. • -
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;i: Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
d duction becomes more beneficial, there is more incentive than ever for homestead fraud: Homestead fraud
auses higher tax bills for all; therefore, HEA 1344-2099 requires taxpayers who receive the homestead
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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.
- =wag ,' - it RN. 1JILD21.1 - -
TaspaverName Property Address State Parcel Number Leal Description:
Cheryl D Goodman 26-20-32-300-000.338-001 001-00338-00 PT SW SW 32-3-9 2.50
Elberfeld IN 47613 AC D-I O
Complete and return to: I Ora \ ‘ S /075 L
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART A;TAXPAM13' INFORMATION .
Owner 1 First Middle Last
C \\SQL 0°AX-Nc\
Mailing Address(number and street city,state and ZIP code)
Same as property address
\C.\\ S \nS t-L$ V;a1( 1 J..Q3 \t-rl \o A3
Spouse First Middle Last
Mang Address(number and street,city,state and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivers License State ID Ntanber(last 5 digits) sate Other(please speaty in Part 4 below)
[Tiffin eFIR IFICATION - -
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 Date /l a
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- *PART 03 ADDITIONAL INFORMATION .
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A
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CLAIM FOR IIOMESTEAD PROPERTY'TAX
J�r' CREDIT/STANDARD DEDUCTION Stale form 5473 (112/1 -90)
1NSTPUC11ONS: See reverse side for filing inshuclions.
CERTfrICA1ION STA'I EMEil r
Y EAI 1
I (We) AA&4', yam cerlily that on [lie Isl day of march. 19
I (We) occupied as our iincipal place of residence the Iullowing described real properly for which a I fomeslead
(Properly Tax Credit is hereby claimed: ❑ I (We) owned U Are buying under conbacl
❑ I lave a beneficial fnleiesl in [lie enlfly that is liable Tor the properly taxes on the properly and Ilral owns the
property or is buying it under a conlracl.
CON TRACT RECORDED
If buying on contract, ree SimPie Owner's t4ame
Recorder's office where contract Is recorded I f lecord Number Page
PROPERTY DESCRIPTION
Courtly to rip Iaxfng District (City, lows, lownship)
11 N00 A -00 Legal Descripliorr n�-' / , sU _ 5O P
II any portion of [lie residential structure or Tire land not exceeding one (1) acre Ihal immediately surrounds that slruc-
lure is used to produce Income describe the use aiid porlion of the property utilized to produce income.
a - - - - 00
PROPERTY OWNED BY CLAIMANT IN OTIIER COUNTIES
Counly
I l owrrship
Counly
1 1 Owrrship
I hereby cattily Ilia above slalements are true, correct and
:omplele.
Signalure
Address (Street, number, city, stale and ZIP code)
ASSESSOn USE ONLY TIIUE TAX VALUE ASSESSEU VALUE 110MES1EAO VALUE 11011- nESrnE1111AL
VALUE
Land nol exceeding 1 (one) acre hnnredialely
surrounding residentiallmprovemenls
Other land
Total rand - fine (1) plus fare (2)
nesidential improvements Dwelling
Garage
Other 6nprovenrents
Total Improvements - line (4) Through litre (6)
Total value - [fire (3) plus line (7)
(1)
1991 Pay 1992
Lesser of 1/2 I lomeslead
Valuation or $1,500
I9 — Pay 19
Lesser of 112 1lorneslead
Valuation or $1,50U
(2)
Signalure of Auditor l �n
(3)
(4)
(5)
(6)
(7)
(a)
I hereby car lily the above is true, Signalure of Assesor
correct, and complete I
errlyurg coon Signalure o Audilor
Dale Signed
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Uale Signed
c7A11nAr11T rlr- MICT101d At I OWANCE
1989 Pay 1990
Lesser of 1/2 1lomestead
Valuation or $2,50U
1990 Pay 1991
Lesser of 112 1lomeslead
Valuation or $2,000
1991 Pay 1992
Lesser of 1/2 I lomeslead
Valuation or $1,500
I9 — Pay 19
Lesser of 112 1lorneslead
Valuation or $1,50U
Signalure of Auditor l �n
f Dale Sign d
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