Homestead_Asa STATE FORM 53569(R3/5-10) . TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6 I.I-22-8 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
(10 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.
*'p,•kte.ti , - - PAR I: PROPER Y INFO MATION _,C +;;!I -
_. .,-. r.;_,
Taxna%er Name Property Address State Parcel Number Legal Description:
Ellen/Robert L Asa 201 S POLK ST 26-18-13-403-000.133-026 PT SW SE 13-3-I 1 .25 AC
FT BRANCH IN 47648
-
Complete and return to: 1111111111111linillliiltEliliffiliniff1111111101111135
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
.7.'' . .■I .. • PART 2: TAXPAYER INFORMATION
Owner 1 First Middle Last
Alen �',0n / As
Mailing Address(number and street,city.state and ZIP code) - - - /Same as -- _ -property address
n 9 2 1
- Last
Rd her f L yn i .511
Mang Address(cumber and street.city,state and ZIP code)
1 I Same as property address
•,:
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, byrclaiming additional homestead deductions unlawfully,he or
she may be liable for back taxes and substantial financial penalties.
Owner 1 Signature Date
.t2Ifl G1g".43i1 44: r4.i'
_ _ ILED
• NOV 7 2012
C116011 COUNTY AUDITOR
�
%--� CLAIM FOR HOMESTEAD PROPERTY TAX
/t��.vy�4
��`" � CREDIT/STANDARD DEDUCTION
•`,,�� State Form 5473 (R2/1-90)
INSTRUCTIONS: See reverse side !or liling instruclions.
(:FRTIFICATION STATEMENT
FORM
HC10
YEAR
I(We) �X�'1 �171G��1J� certify that on Ihe tst day of March , 19
I(We) occupied as our principal place of residence Ihe loliowing described real property (or which a Homeslead
��perty Tax Credit is hereby claimed: �(We) owned ❑ Are buying under conlract
� Have a beneficial interest in Ihe entity lhal is liable for the properly laxes on lhe property and Ihat owns lhe
property or is buying il under a contract.
Couniy
CONTRACT RECORDED
on conlract, Fee Simple
where con(ract is recorded I Record Nurnber
PROPERTY DESCRIPTION
Township Taxing Di ity, I , lownship)
� �_� Legal Description P� � �� /'? ��_ � I �as
i J
II any portion of the residential strucWre or ihe la�id nol exceeding one (1) acre that immediately surrounds that slruc-
lure is used ro produce income describe ihe use and portion of the properly utilized lo produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
ASSESSOR USE ONLY TRUE TA% VALUE ASSESSED VALUE f10MESTEAO VALUE NON-RESIDENTIAL
VALUE
land nol ezceeding 1(one) acre immedialely
surroundingresidenlialimprovemenls (�)
Olherland (2)
Tolal land - line (t ) plus Iine (2) (3)
Residential improvements Owelling (4)
Garage (5)
Olher improvements (6)
Tolal improvemenis - line (4) tluough line (6) (7)
Tolal value - line (3) plus line (7) (8)
I hereby certify the above is lrue, Signalure ol Assesor Date Signed
correcl, and complete
Verilying Aclion - SignaWre ol Auditor Date Signed
1989 Pay 1990
sser ol 1/2 Homestead
Valuation or $2,500
Signalure ot
�
STANDARD DEDUCTION ALLOWANCE
1990 Pay 1991
Lesser of t/2 Homeslead
Valualion or $2,000
��
1991 Pay 1992
Lesser ot 1/2 Homeslead
Valuation or $1,500
19—Pay 19_
Lesser of 1/2 Ftomeslead
Valualion or $1,500
Dale
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