Homestead_Barrett (6) STATE FORM 53569(R)r8-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1-222-8.I
IMPORTANT NOTICE TO.HOMESTEAD PROPERTY OWNIRS ., n
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
1 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.
PARTI: PROPERTY INFORMATION ,Fr ,- '. . `';r
Taxpayer Name Property Address State Parcel Number Leral Description•
Scott L Barrett 104 W JOHN ST 26-18-13402-000.645-026 WALLACE&FRENCH 282
FORT BRANCH IN 47648
Complete and return to: Itl IIN 911{IINWENI 111111111 LIN1]II[t 1011'1I1li(I
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
' PART 2: TAXPAYER INFORMATION :' , , ,
Owner I First Middle Last
Scot LEE BArr �
Mailing Address(number street,city,state and ZIP code) l came as property address
i - ,
/o /(J ✓V . -3-0 k N -s�; Fort- B rAme h -, =,1j . L 7 cotf 8
-
-
Spouse First Middle Last
Th. e rzsM ANN • EArre_—H-
Maaing Address(number and street,city,state and ZIP code)
Same as property address
011 WC ell“/ 54 . For-FErANCk sip �t7 "1- 8
+
e-c' - _x�i . u.,� 4w4. a }::. -i'. :re_ » .
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.
Ownerr1Q1 Signature,, (. ,/ Date
A
/%
FOPM HL'10 1979 � l . ' � •.
.tir.
Pre5cri0ed By S�ate Board ot la. Commissfonert - _ r: , '�
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19`�
_ SEE BACK FOR FILING INSTRUCTIONS
ia Be Filetl in Duplrtate
9�
�'�(We) � certify that on the 1st day of
rch, 19 I, (We) occupied as our principal place of residence the following described real property for
whicK a Homestead Property Tax Credit is hereby being claimed: '
I, (We) LSYowned ,
�J//j d�"oa
❑ are buying under contract . . ����(y"� .
❑ have a beneficial interest in-the tazpaye'r -
Property Description in
Taxing District (City, Town, Township):
Parcel Number �
Township
'li
or legal description shown on tax, statement:
��x�.c��--�" ,c� a��
If buyin�n�c�itr� wi rs name ��� simple owneq `
� � �y
�Sfitract recorded in .Recorders Office - Record No. Paqe
If any port��UfQFt� q��ntial structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is used to pro uce income, describe the use and portion of the property utilized fo produce income
Any other counties in which individual owns or is buying real property:
I hereby certify the above statement 1is true, correct and complete:
�. _ �. � n i
County Township
sneet nmeeu . ^ �-.... .. ury. maie ana t�o �e
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 immediately
surrounding residential improvements
Other Land �
Total Land
Residential Improvements Dwelling
Garage
Total
Oiher Improvements
Tot�i Improvements - Line (6) plus (7) equals (8)
'�:by certify ihe above is irue. correct. and complete.
Sgrawre o� Assesmr
True Cash
Value
(�)
(2)
(3)
(a)
�s�
(6)
(�)
l8)
- ACTION BY AUDITOR -
Assessed
Valuation
v
j�����/�j�
oa:e
Homesiead
Valuation
Q 3-��1
Date: —O �