HomeMy WebLinkAboutHomestead_Garrett (10) STATE FORM 13569(R:/]JA) TREASURER FORM TS-IA
AIWOYFD BY STATE BOARD OF ACCOUNTS,2039- PRESOBIEO BY THE DEPARTMENT OF LOCAL o vrla lurr FMANCE IC 6-1.1-224.1
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) n a
/I S a5 92o /Cvf -s 2//a//&r
State Parcel Number
Nu mber -3/4i.,
d'- /7-O4' / - doo. / ✓qN oR?4,D c,esoN c O U
• s
I N ry
400/?
PART 2:TAXPAYER INFORMATION
Owner I First Middle 4, Last
Mailing Addre umber and street,city,state,and ZIP code)
la-Same as property address •
J7?s it 9f0 1i J w�ivs ///c SY�'ry->z S
"
Spouse First Middle 'Last
Mailing Address(Number and street,city,state,and ZIP code) I I Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
Stale
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 dedu ions unlawfull ,he or she may be liable for back taxes and substantial financial penalties.
'�O(/mer I Si It r� o� -�p���/��,�- Date
INSTRUCTIONS
■
1
:b- •" CLAIM FOR HOMESTEAD PROPERTY TAX � YEAR
y�.� CREDIT/STANDARD DEDUCTION , HF �R�M
State Fum 5473 (R8 / 7-07)
•� w. '� Prescnbed by Ihe Departrt�en( of Laal Govemment Finance �
INSTRUCTIONS: See reverse side )or filing insWcfrons.
��e� � certify Nat on the 1 st �a1 of March, 20
I(We) occupi as ou rinapai place of residence the �ollowing descnbed real property for which a Homestead �rt�Ta� ��Al�is hereby daimed:
,� I(We) owned ❑ Are buying under contract
Have a benefidal interest in ttie entity Nal is liable fw the property taxes on ihe property and that ams the pro�.¢y��nder a contrad.
If buying om m�traq, Fee Simpe w+nefs name
Recorders offica where cwNad is recorded
I
Counry Township
- �- i�/ 14�IN71-
If any poAion o1 the residential aWCture or
of ihe property Wtized lo produce income.
Record number � Page
Taing disVict (city, iown, (m+vnship)
1-F�O� I Is �he WopertY in queslion:
� ❑ Real property ❑ Mobile Home (IC 6-7.7-n
eacecding one (1) acre Ihat immediately surrounds Uwt sUUCture is used lo produce income, descnbe the use and portion
�rr�wooy, 3p� i�f
-.- . .: . .
Caunty 'Toxnship Counly Twvnship
I hereby certify the above statements are We, covect and complete. 5� n re oi t
s umbeiaMsLeeL ' slafe,andZ/Pcoda)
3
.- .
, . .. . ,
„.. �
Land not exceeding 7(one) acre immediately . , �
surrounding residential improvements. (�� . '
Other land (p� -
Ttial land (line 7 plus Iine 2) (3)
Residential improvements orMnually �eilin9 (4) . '.;.:�, (' .. �;�� ;_ -
Assessed Mobile / Manufachired Hwne I _
Garage �5) ' -:-a :
Other improvements (6) � • -
Ttlal improvements (line 4 lhrough line 6) �7) �
Tcial vafue (line 3 pha Gne n (g�
I hereby certify fhe above is We, correCt, and SignaWre of Assessor Date signetl (mmth, day. yee�
complete.
Vaitying aaion - SipnaWre af Fwdimr pate signed (ma'N, day, yea�
�u _ pay 20 _
leuer ot 1l2
Homestead Valuation
w
Signature of Audiinr
45,000 for 2007 pay 2008 42,000 tor 2010 pay 2071
44,000 for 2008 pay 2009 41,000 for 2077 pay 2012 $
43,000 for 2009 pay 2070 40.000 payable after 2012
�
�