Homestead_Atchison •
STATE FORM ERA(RI 18-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LO CAL GOVERNMENT FINANCE IC 41.1424.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
Pflnceton, IN 47670 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
• F IL 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 Deparunent of
1�J Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
•
APR 1 S 2011 Taxpayer Name Location Address
n`-rs Atchison, Benjamin 0 Jr/Mary J
�V\7 106 E Mulberry
GIBSON COUNTY AUD TOR Fort Branch IN 47648
53
Benjamin 0 Jr/ Mary J Atchison Jr. 1101011 I_DIII DII 1 011101011[II I ll 110101 DIID II_II_ii 1 11111/110[III 1101 DI I I_II
106 E Mulberry
Fort Branch IN 47648-1518
IIIIIII1IIIIIItrIIIIIrIIttIIIIIIIItIIIIll1llllll'IIIIIII'Illlll'I State Parcel Number Legal Description
--- -- - ---- ---"- '— '— -26.18=24=202:000:030-02674ccRARY-ETAL-85PT------ _
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2: TAXPAYER INFORMATION
V i - -_ - - _. Pita Middle _. Last
ccir
Mailing Address(number and street,city,state,and ZIP code) lame as property address
/9 £ M/4 'i v 5r
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) e as property address
l9 et/ y
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
V
� wan� �xc io �s�
PRSCfIEEE BY $�dI! BOdIE 0� Tdz tommissioners
CLAIM FOR HOMESTEAU PROPERTY TAX CHEDIT FOR YEAA 19�
70 & Fi1W in MDlicate
V
^��/�� SEE BACK'FOR FILING INSTRUCTIONS �//- pDD3D-oo
I, (We) '� ��-e"���-�--�- (�'-�X`•� �- �� f�at on the 1st day of
.
3rch, 19 �(We) occupied as our p cipal pla�dence the following described real property for
.nich a Homestead' Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial interest i the taxpayer �,/ �
Property Description in �-�-�'-'-�'�" County q �.`��*'"'/ Township
Taxing District (6iEy, Tewn ownship): J� /�-�"-�
Parcel Number or legal description shown on tax statement:
� �.w, 8s � .
If buying Ofl contract: Owners name ��� simv�e ownep
Contract recorded in Recorders Office - Record No. Page
If 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
Any other counties in which individual owns or is buying real property:
I hereby certify the above statement is true, correct and complete.
� /J . GZ�.c..x�,._i,.J .
'Sig`uture
^ Strret AOaress
)l r)t.i
�`
County
Township
Ciry. Siare ana Zio CaCe
' Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immedia ly
surrounding residential�r.@ve�1+e�nt� �
Other Land � J.� rJ
Total Land 1982
Residential Improvements �AY 10
�1, 0.
A���j�R
Other Improvements
True Cash
Value
(�) 9So
(2) —
�s� So
Dwelling �4) ���"
Garage �5> -3 %'� l' n
Total �6> ��
Total Improvements - Line (6) plus (7) equals (8)
I�by certify the above is true. correct. and complete.
�. , la� `�n c¢.,
Signa:ure oi Assessa�
Approved:
(�) —
- ACTION BY AUDITOR -
Assessed
Valuation
3�0
3�0
�
• ��i -
Date
Date:
Homestead
Valuation
' '.