HomeMy WebLinkAboutHomestead_Blaine SLUE FORM 53569 111318-10) - TREASURER FORM TS-IA
APPROVED BY STATE.BOARD OF ACCOUNTS,]M PRESCRIBED BY'DIE OFPARTMEVE OF tOCAI.GOVERNMENT FINANCE 1C 6-I.t-33-.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
Princeton, IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore,
HFA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to'e eive the
cfit I tgs.and information provide additional wipe confidential information c necessary to allow county government
zed county officials.er Thei�otlment o
Tin s.This information will n k t toying and can only err accessed authorized aunt 'o better The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
APR i 8 tAt Taxpayer Name Location Address
C 9 Blaine, Michael P/Carol A
402 N Railroad ST
01880N COUNTY AUD TOR Fort Branch IN 47648
2138
Michael P/Carol A Blaine 11010111.01110[[ [00111[I11 01101101111101101111101101.111101100110111011111
402-N Railroad St
Fort Branch IN 47648-1026
11'1111"'1'111'11"Illy'1111111!Illlll'I'I'Illllll'I'I"II'IIII State Parcel Number / Legal Description
26-18-13-402-001.040-026 /fvtALLACE 8 FRENCH 283PT284PT
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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
First Middle Last
Michas( 010.1n
Mailing Address(number and street,city,stale,and ZIP code) ® Same as property address-
A/ Ircuiroar/ & . {rt gra -no A .1'N `/76V/ - %oa6
� -
Spouse First Middle - - Last
C0 ( A � I ne__
- - Maifmg Athiress(Nnmtie�-iva4 eitystate and ZIP eode)C.' 12LSameas property address _
4/0 a- Ai kal /p0ctc Sf lor -5/76 V/ -/Da6
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PART 3: CERTIFICATION •
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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�`5T" - CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
i ',
, ,, CREDIT/STANDARD DEDUCTION HCio
` �i State Fortn 5473 (R2 / 692) .
�<, �
, INSTRUCTIONS: See reverse side la filing instructions.
�� � CE TIFICATION STATEMENT
I(4Ve) rtity tha on e 1 ay of March, 19_ '
�
I(We) occupied as our principal place of residence the following described real property for which a Hom i is he y med:
(�I (VJe) owned ❑ Are buying under contract � � S N COUNTY q�p�TOR
❑ Have a beneficial interest in the entlty that is liable for the property taxes on the property and.that owns the property or is buying under a contract.
� CONTRACTRECORDED
It buying on contract. Fee Simple ownefs name
Remrders oflice where conVact is recorded ' Recortl number Page
PROPERTY DESCRIPTION
Counry - Township T" di n(dN, �, rownsAip) -
Parcel number Legal descnption '
� /' /0 '
If any portion of the residential sWCNre or ihe IanA not exceetling one (1) acre that immediatety surtounds ihat suucture is used to produce income, describe Ihe use and portion of
ihe property uWized to produce income.
PROPERTV OWNED BV CLAIMANT IN OTHER COUNTRIES
Caunry Township Counry Township
Signature ot cla'unani
, ereby certify the above statements are true, correct and complete.
Address (number antl sneeC ciry, stare, ZIP crode) �
ASSESSOR USE ONLY TRUE TAX � ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE • VALUE
Land not exceeding 7(one)acre immediately (��
surrounding residential improvements.
Oiher�and (2)
Total land (line 7 plus line 2) � (3)
Dwelling (4)
Fesideniial improvements
Garage (5) -
Other improvements (6)
Total improvements (line 4 fhrough line 6) (7)
Total value (line 3 plus line 7J (8)
I hereby certify the above is Irue, correct, and Signature of Assesor Date signetl
complete.
Ventying action - Signamre of Autlitor Date signed
�� STANDARD DEDUCTION ALLOWANCE
19_ Pay 79 _
Lesser of 1/2 Homestead $
Valuation or S2,000
Signature of Autlitw - Date siqnetl
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