Homestead_Hornby STATE FORM 53569(R3ls-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1-22-9.1
a 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 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
fraud.
s a - PARTI-PROPERTY INFORMATION It
Ta was er Name Property Address State Parcel Number j,eeal Description:
Brian Hornbv 9243 S 1300 E 26-21-29-300-000.280-001 PT N SW 29-3-8 3 AC
- OAKLAND CITY IN 47660
Complete and return to:
IuliilnluG f"lllGuraIiUrlInIf911M11JIt I 1i1111711.111111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
. . - . . - - s
Owner rIII First / Middle / • Last
/J r IC.n t:i,, / l/6 r n b,�
Make;Address(number and street,oty,state and ZIP code) /�
1 2 qJ` S, / 70 E- Rc(\ /4/1 J c t '_4, L/ gasor0)adaess __
spouse First Middle Last
Mailing Address(number and street.city,state and ZIP code) Same as properly address
924135,
Social Security Number(last 5 digits) ' Drivers Licenselstate ID Number(last 5 digits) Sims Omer(Please speedy m Pan 4 below)
? .,,- Xi.. . _1.: PART 3:CERTIFICATION.:41'u,Vetw, c a zza iv+1:4 a ." , CI
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 t Si hue /4 J Date <-'-' /2
CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R6 /4-03)
Prescribed by the Department of Local Government Finance g
INSTRUCTIONS: See reverse side for filing inshucb'ons. jg)
yk)
LyYEAR
I (We) V A 0 certify that on the 1st day of March, 20_
I (We) occupied as our principal place of residence the following d s bed real property or ich a Homestead PmperiR1*1Predjti's {mreby daimed:
❑ I (We) owned ❑ Are buying under contract
C7
GIBSON COUNTY AUDITOR
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.
CONTRACT' RECORDED :u•rr:_.:z�'�[x.v'�iJ'�i" "ts,.:` ""k ti
If buying on contr4d, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
vyY
�.... -' �..s.�. �zSli��,R'�- zr�'- `"R��2. P,ROP,ERTY:OWNED'.BY CI:AIMANT;IN'OTIiER`COUNTIES �' ""� d`t
County
County Township
Township
Taxing district (cif , fownship)
Parcel nu ber n� ,'11, r,1/ (�'�
00 O _ - v
Legal description
Is the property i estien:
I proparty ❑ Mobile Home ( /.C. 6.1.1 -7)
N any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income. describe the use and portion
of the property utilized to produce income.
07 -
vyY
�.... -' �..s.�. �zSli��,R'�- zr�'- `"R��2. P,ROP,ERTY:OWNED'.BY CI:AIMANT;IN'OTIiER`COUNTIES �' ""� d`t
`"'-"` ppsy��Y1"��"="
County Township
County
Township
I hereby certify the above statements are true, correct and complete.
)Tne of claimant
41n (number and street, city slate, ZIP 2code)
d
„y :` ASSESSOR U E ON Y �y
?RUE TAX
ASSESSED VALUE
rAT1100 %'OF SfV
P-HOMESTEAD�7
�,VALU.a�c::
i �'x NON, RESIDENTIAL
�fi�.L$SVALUEra�%
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
vauauon or 535.000
8 fi=r° Sir
"x
2z ia- du+=.v
Other land
2
()
= -. 'M
Total land (line 1 plus line 2)
(3)
lResidentiel
Dwelling
(4)
- _ ,ski`
��_ � -
impro vements or Annually
Assessed Mobile / Manufactured Home
Garage
(5)
c
,..sf,�' a '•T T'�
, F.
r`4ss-'� t;rc�R {:bx con"
Other improvements
6
G._
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(0)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
",�".p?" s`- m--o STANDARD.DEDUCTION.ALLOWANCE ,,.Fp ; ,.. �; "•-. . s � 4'k�v+,3' 4°_�,�+
20_Pay20_
Lesser of 112 Homestead
TS
vauauon or 535.000
Signature o
T F
Date signed