Homestead_Bulloch STATE FORM 53569(R3(s-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1 22_-8.1
' 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
',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. v
PART!: PROPERTY INFORMATION ; _ :''',1.r :-., r y;
Taspaser Name Property Address State Parcel Number Leeal Descriotion;
Norman C/Nancy.1 Bulloch 202E WILLIAMS ST 26-18-13-402-000.103-026 GENUNG&WALTERS 181
FORT BRANCH IN 47648
Complete and return to: Ignil Ilippli piligioLlull wL gigif11(JJao
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
' ' PART 2:TAXPAYER INFORMATION•
Owner�1 First Middle Q �� last
�UC�tYY�Ci ti A ock
Mailing Address(number and street city,state and ZIP code)
i/I Same as properly address
20 Wittige rist5 5'-12- rF 7xa. nC- 1/4A- -77-10
- --
Spouse First Middle -.3 last
ALk Ma Address and street v C�
Matting ( eel city,state and ZIP Code)
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 sne 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 Fable for back taxes and substantial financial penalties.
Owner 1 Si ure � � Date
` , :;:. ;..Are-
• FILED
NOV 5 2012
f�
Yt'S.") cnvi;Tr s,uc "CR
wan� xc io ie�s
ReSttiheE By State BOdrE ol Ta. CAmmissioners
CLAIM f0A HOMESTEAD PROPERTY TAX CHEDIT FOH YEAR 19�
��� SEE BACK FOR FILING INSTRUCTIONS
����
� �
To & FileO in Wpli[ate
.(We) �, , ����- � certify that on the 1st day of
�aiarch, 19� I, (We) occupied as our principal place of r sidence the following described real property for
which a Ho estead Property Tax Credit is hereby being claimed:
I, (We) owned . �l/ i ���1% � ' � �
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in �-�-�-a-�� County ��� Township
Taxing District (6Hq,- Town, Texmship): �o-T-� �u-�
Parcel Number or legal description shown on tax statement:
,�,�-kJ �Ld . /S� /�,� .
If buying on contract: Owners name ��� �""O�e owner�
Contract recorded in Recorders Office - Record
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: County Township
�hereby certify the above statement is true, correct and complete.
�
.l i� ,
'Signawr Shret AEdRSS Ciry. State an0 Zip Cope
' 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(on�acr� imm� atel'�
surrounding residential im fove ents , �
Other Land
Total Land �UN 1 � j979
Residential Improvements Dwelling
/��A<-�=4� 9e
�� T�
AUDITOR
Other Improvements
Tr �� Improvements - Line (6) plus (7) equals (8)
I�oy certify the above is true. correct. and complete.
$igeWWr! OI A552550e
Approved
True Cash
Value
(t) Co 0 0
(2)
(3) � o 0
(4) �
(5) �
Assessed
Valuation
�a o
���
�s� �-�-e'a�7o �'
��� � —
(8) �-�—�T° --��1'"
Homestead
Valuation
�
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`7'}2a.�- / 8, � � � 9
Date �
Date: