HomeMy WebLinkAboutHomestead_Adams (6) STATE FORM 53569(R315-10) a TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,1009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1 22-5.I
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
�auses 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.
PART I:l PROPERTY INFORMATION •I
Taspaver Name Property Address State Parcel Number Legal Description:
Mark D Adams 905 MOHAWK DR 26-19-18-101-001.003-026 LITTLE YORK VILLAGE 16 PT/17
FORT BRANCH IN 47648 PHASE I
Complete and return to: IlifihIDUIIlBn[I11lllllu1fffP111111 lIftPHWUfti®oll
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
E% ' . ; PART 2: TAXPAYER INFORM
Owner 1 First Middle Last
MACY Q. /-%9ir.S
Mailing Address(number and street,city,state and ZIP code)
Same as property address
Spouse First Middle Last
shzwny p Mains
Mailing Address(number d street,city,state and ZIP code)
i 1 Same as property address
goy to katAi L P if grzh� , Tt i 147c1&
r4 rs
Each undersigned certifies,under penalty of perjury,that the above and foregoing inrormation is true and correct and mat he or sne is eiigibie 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
CLAIM FOR HOMESTEAD PROPERTY TAX � YEAR
CREDIT/STANDARD DEDUCTION FORM
State Fam 5073 (RS 17-07) HC10
�,. 1 Prescnbed by 1he Department of Local Govemment Finance
INSTRUCTIONS: See raverse side /or filing inshucfions.
� M�e) �� � W� � �.i .P�di Kn ✓1% certify that on the 1 st day of March, 20_
I(We) oxupied as our prinapal place of residence the following described real propeAy for which a Homestead Property Tac Credit is hereby daimed:
I(VJe) owned ❑ fve buying under contrad
� Have a benefidal interest in the entiry ihat is liable for the property faxes on the property and that owns the properry or is buying under a contract.
If buying on conlracl, Fea Simpe ownefs name
Recordefe offica whue contracl is recorded
Counry Toxrrship
Patcel number
Legaldescription
disUict (pitv, town,
m
Record number � Paga
I I �teal property ❑ Mobile Home (IC G7.7-n
It a�ry porUOn of the resideMial aWCWre w �he Wnd nd exceedi one 1 acre �hat immedi �
of the proparty uUGzed b pmduce inmme. � () �Y wrtounds lhat sinccure is used tn P�oduce'vimme. tlescriEe the use and pwtion
at�-��-�g - �o �-�a1 .�o3 -oa (�
..- . .: . .
Counry Toxnship County Twvnship
ignaWre of daimam
I hereby certify ihe above statemenLs a2 We, correct and complete. �� l� ,���
�ess (number ar�d streeC city, state, and LP e)
�_ � � � .� • �
��.•
Land not exceeding 1(orre) aae irtmediately �' � � 3:.� . �
surrounding residential improvements. - _,;;,. � ;; _. ; . _ . .
Other land (p� .� -
Tdal land (line 1 plus line 2) (3�
Dweliing (4) _ f �
Residenfial improvements or Mnualty
Assessed Mobile I ManufacWred Hortce -- °y '
Garage �5) ,:,. . � . r .�� [
f _a;.r.:.�:_.. ��;
..y.
- :.o:,
Other impravements (6) �
7Ual improvements (Irne 4 tivough line 6) �7)
Tofal va�ue (line 3 phs Wrre n �8)
I hereby certiy the above is We, corrsct, and Signawre otASaessor pate signed (month, day, yeer)
canplete.
vaifyirg aclion - sigratura of �tor Date signed (month. EaY. r��)
�•'� � � � •
_ pay 20 _ qs.ppp for 2007 pay 2008 42.000 for 2070 pay 2011
Lesser of 12 qq.ppp for 2008 pay 2009 41.000 for 2011 pay 2012
Homestead Valuation $
« 43,000 for 2009 pay 2010 40,000 payable after 2012
Signawre of �ta Date signed (monN. daY• Y��