Homestead_Devine STATE FORM 53569(0.3/8-10) 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 :t., 4,
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
•auses 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.
.1 , > PARTI PROPERTY•INFORMATION ' ' 1~- r 'F,
Taspaver Name ?rooerty AddreSI State Parcel Number 1.esal Description: ,
Warren L/Karen S Devine 902 BLACKFOOT DR 26-19-I8-101-001.025-026 LITTLE YORK VILLAGE 56PT/57
FT BRANCH IN 47648 PHASE 1
^_ Complete and return to: IIIHII PDIII191I?P Cp!lulli::IIIMIIIIPIIIhIfFIUQJI U
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
-. PART 2:TAXPAYER INFORMATION - : `'!' 'LT r`cj
Owner 1 First Middle Last
Mailing Address(number and street city,state and ZIP code) I I Same as property address
90 1. /a.(/' 7& 77r-,'✓e
S se First Middle '' Last
j/Lr�1? C.Sign. eiVi ne>
it
Address(number and street city,state and ZIP code) 1
n_ _ L 72711/e--/ ) /� r��as property aad(ass J�
90 2CIL�fd�T COnL&zi4,_LAI `t%lam//
r .-.,- : '1 ., ._i . : . ..... PART 3: CERTIFICATION s air-f Hi: ..m_i4 ,;C::
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 1 Sir/ "o-/ Date
.. sr '+t.."'
FILED
Ill DEC 3.1 2012
C.J.n�—�-Y
Ulb5014 COUNTY AlIIVInITOR
•
�`�rt�� � CLAIM FOR HOMESTEAD PROPERTY TAX
�� ' CREDIT/STANDARD DEDUCTION
� J Siate Form Si73 (R2 / 5-92)
'0.�
INSTRUCTIONS: See ieveise side lor filing instructions.
FORM
HC10
YEAH
I �We) _ _��/b- � L�W Y 1 certify that on the tst day of ar , _
I fWe) occupied as our principal place of residence the following described real property for which a Homestead Property T�ersditjsqerfqy,�aimed:
►' 1 V `J`Jt1
� I(We) owned ❑ Are buying under coniract
LJ Have a beneficial interest in the entiry that is liable tor the pmperry taxes on the property and that owns the pro�or is in un�a contr�t.
If buying on contrad, Fee Simple owner's name
Recorder's oHice where coniraa is recortletl
PROPERTY DESCRIPTiON �
County Township Taxing tlistrict (crry, fown, township)
•cel n mberQ — _ \ Legal destription
V�%
If any ponion ot the resitlenlial struc:ure or the land not exceetling one (1) acre
ot ihe properry utilized m protluce inmme.
_ :i - �-.
Record numDer Page
Counry
that structure
PROPERTY OWNED BY CLAIMANT IN OTFiER COUHiIES
ip Counry
, � /
produce income, describe ihe use and portion
� certity ihe above statements are true, correct and complete. "''""'"'%' °%� ////r—
� //(/��/ �/
(number arrd streef, aty, s(ate, ZIP cade) �
� 9�L d�tic%fopi� aY �� /�/..nG'�� l� ?`7�y�
� ASSESSOR USE ONLY � �UE TAX ASSESSED HOMESTEAD � NON-RESIDENTIAL`
, - .VAWE VALUE VALUE . � VALUE
Land not exceeding 7(one) acre immediately .- ' �
surrounding residential improvements. (�)
Otherland (p) � ` �
.��° -�'
Total land (line 1 plus line Z) (3)
Dwelling (4) . .. �. . � � `�
Residential improvemems .-
Gara9e (5) � ' ..
Other improvements (6) -
Total improvements (line 4 th�ouqh line � (7)
Total value (line 3 pLs line 7� (g)
I h0reby ceRify Ihe above i5 ime, correCL and Signature of Assessor Date signed
complete.
Ventyirg attion- SgnaWre of Audibr Date sgnetl
� STANDARD DEDIJCTION�ACLOWANCE' � '.4 �
19_Pay79_
Lesser of 1l2 Homestead
Valuation or 52.000 5
SgnaWre of Audiror Dare signed