HomeMy WebLinkAboutHomestead_Do STATE FORM 53569(R2/619) TREASURER FORM TS-IAI
APPROVED BY'tTATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1.22.8.1
e
- ro ' I' 1.EO 1J'. mule g ng o)Lr . o. r ir(o(mum _• . ,
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
s. dard 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.
-
ART 4:. . .OPE•Rt �llXQi
Taipaver Property Address State Parcel Number Least Dncdption:
NI 912 MOHAWK DR 26-19-18-101-001.177-026 LITTLE YORK VILLAGE PHASE II
i1Q�� Fort Branch IN 47648 23
Qi tiJ L�:- -
Cornp(eteadp Poaoc� I®HHH�HUIMIllnmHUh®HU111MMIIiH7�H
ONGOVNci GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
Ca,G.
PART TiAXPA%ER INEORAIATION r ,
Omner I Fist Middle Last
MY T+t I Do
Mailing Address(number and street.city,slate and ZIP code)
r I Same as Property address
Fist Middle Last
KlM . VAN Do
Madre Address(amber and street,dty.state and ZIP rode) I ktame as property address
` -- ° ¢r/ '€_ y tpi t >. t GERI IFICA !ION _ "K" " ai
+i-si... 4i
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.
Dena 1 Signature pate
_; .
; CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
t / Staie Fwm 5473 (R6 /!-03;
Presuibed by the Departmem of Local Govemmenl Finano:
INSTRUCTIONS: See revcrsC SidC !oi /ilinq insVUr.Gnns.
e�-
��
FORM
HC10
YEAR
���
� 4^'e� �en�y ��P R�ne i�� �005 rna«n, zo_
�I/(VJe) occupied as o r principa place of residence the following desaibed real property (or which a Homestead Property Tac Cre�d!it �is hereby daimed:
YJ I(We) owned ❑ Fve buying under contract �i�, ��+ �l
� Have a benefidal interest in the entity that is liable (or the property taxes on Ihe property and that owns (L��$�}jrQ01J91$iYyi�b� contract.
If buying on contraa, Fee Simple ownefs name
olfice where coniran is recorded
Counry
� =._�•�'�o-0
I( any portion ol0�e resiAential sWCWre w
ot the property utilized to protluce income.
D��'1-��1�
Tavnship
�
RewrO number
Ta�ing dislricl
Page
/,n IsNe�fope7Eyinquestion: '
l y� ll � 3 eal D�operty ❑ Mobile Homo Q.Q 6f.7-7)
one (1) ac Ihat immediaiety wnounUS Ihat sWCtwe is used to praduce inwme. desaibe ihe use and portion
.
!:_�''': F�.`u''-.. � ` '�r.. � •" ' � --� : .-2 �°P,ROBERTY,OWNED��BY CLAIMANT�IN OTHER"COUNTIES� � . "� ? «;��_•�-?� � - � `"- - �-� �
County Toxnship County Tavnship
I hereby certify lhe above statements are true, conect and complete. Signawre o1 claimant
Adtlress (numbu and sheef, dry, 5fafe, ZIP Code)
IJ /2
Fy`�- �5,}r c ASSESSOR'USE ONLY __ . TRUE TAX ASSESSED VALUE i�HOMESTEAD � NON-RESIDENTIAL.
. . _� � VALUE', :=; ,_ - �=;-i:rVALUE, - ' ;, �
_..,n:1 f....2-....:.. . �. ::'6,s . _..- '- �-. . ', � - VALLIE . AT 100 /a�OF_TTV
Land not exceeding 1 (one) acre immedialety . - '��'��:_•'-�""" `- � � .
suvounding residenGal improvements (�) . . "'- � � . I
Otherland (p� - ._
Total land Qine 7 plus line 2) (g� '
Dwelling (4) .i.�. !- _ ._ _ ..
Residential improvements or Annually , �. ``' _
Assessed Mobile / Manufacturad Home ��'�'`- '' - _� .
Garege (5) - - �,
. .>, . .
Olher improvements (6) I
7aal impmvements Qine 4 through line 6) �7�
Tdal value (line 3 phs line 7) (g� I
I hereby certify the above is true, cortect, and Sgnawre of wcseswr Date signed
complele.
Ventying acl'an - Si9naNre ollwtlitor Date signed