Homestead_Mason STATE FOR.1 53569(R118-09) TREASURER FORM TS-I AI
APPROVED'BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.I-22-8 I
F
IMPORTA NO,T;IICE+TO HOMESGTE 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
homestead fraud.
a��••fif}}--PART Ir PROPERTY2IN FORMATION re ��qq��,1' " ' ,-
3t'. st3 � � .... - d4xii3i;&4�"ig�' �•'iMtut?�.n-,s �vs' § t .,_gJ• .yr.
Tastes er Name Prowls Address State Parcel Number Leal Description:
James T/Sharon L Mason 700 S 26-20-13-300-000.499-001 PT NE SW 13-3-9 1.41 AC
OAKLAND CITY IN 47660 / D-8
_
Complete and return to: IDlhIUf:IIfllIfO[1II[fUIHIlhi]II]II]f 1111 3fE E
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 '
. r ;" !.*T-;.�1 " T, 4'" '„,*t t 'a d,tgenXRTe2 'T t'X R A Y E R I 1 N F O R R M A'T I O r'4 1, .F 2. i t. 'il t;..X !`c
Owner 1 First Middle /L��T -/ Last
Mailing Address(number and street city,state and ZIP cede)
I I/'same as property address
Spouse First _ Middle Last
al Att/A) L- Mficleti,/
Mailing Address(number and street dry,state and ZIP code) Same as property address
br: i,$,- +"`., y.:: ' n
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
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CLAIM FOR HOMESTEAD PROPERTY TAX
i CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5 -92)
rau
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC70
CERTIFI TION STATEMENT
I (We) certify that on the 1 st day of M , 19
"e) occ ed as our principal place of residence the following described teal property for which a Homestead Property Tax Credit is he clai
,_, I (W caned : ❑ Are buying under contract. �' - - do:1 ",TY 41JDITOR
❑ 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
t buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
- PROPERTY DESCRIPTION
County _
Township
Taxing district (city, town, township)
rcel n mer Q
l('/l�J
I
Legal descriptio
— —
It 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.
- -/3 - o -ovO. -G0/
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
TRUE TAX
VALUE
County
Township
County
Township
—eby certify the above statements are true, correct and complete.
Signature of claimant
Address (number and street, city, state, ZIP code) r
Other land
— . / /
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
"
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
-
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pfu line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
-�. - STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 112 Homestead
S
Valuation or $2,000
Signature of Auditor
Date signed