Homestead_Epperson STATE FORM 53569(11315-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1A 22-8.1
'' '= ' . °IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS .i »i.7
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
si eduction 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.
gritNerl . - - . —TT PARTIF PROPERTY'INFORMATION • ,1>," ,•' i- rr 3# :;-itcg.7.
Taspat'er Name Propem Address State Parcel Number Leval Description:
Charles P Epperson 202 S MAIN ST 26-18-13-704-000.820-026 OLD PLAN 8PT/9PT
FT BRANCH IN 47648
Can:pletc and return to: IE111 1111111EnMIM II1111
Qll11111 OEM U1111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
e PART 2: TAPAYER,INFORMATION ,•'-• ' � ��^ ?rt -
Owner 1 Last
/ / First Middle p
Mailing Address(number and street ci'ty.state and ZIP code) `,
0 5o tc/ t"y *A///srete �Same as property address
JODpae First Middle last
MaLirc Address(cumber and street city,state and ZIP code) 1 Same as property address
Social Security Number(last S digits) Drivers License/State ID Number(last 5 digits) State Omer(please specify in Part 4 below)
p �p� _
1 '.. a-=--c - i } --- - `.PART' CikTi `."'P -ex , ^ '?-i.3-.) s s.'- 474si21
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.
Ovine i. .Lure Date
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Siate Fortn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side lor (iling inshuctions.
FORM
HC10
YEAR
.� CERTIFICATIO TATEMENT
I(We) � Aify t t o the 1 of ar , 19_
I(We) occupied as our principal place of residenc the oilowing described real property for which a Homestead Property C '' eb laimed:
❑ I(We) owned ❑ Are buying under contract DEC 1 1 Z���
❑ Have a beneficial interest in the entity that is liable for the property tazes on the pmperty and thai owns'�e property or is buym der a contract. _
-ti.
- CONTRACT RECORDED ����`p/,; � �
It buying on canvact, Fee Simple owners name ' DITQR
Recordets of(Ke where conVact is recorded Record number Page
PROPERTY DESCRIPTI N
Counry Township - Tauin distncl a. to , �)
Parcel n mber Legal d ipti
If any ponion of the residenGal structure or the land not excee mq one (7) acre that immediatety sunountls ai st nure i used to r e in me, descn6e the use antl portion of
Ne property utilized to D��uce incame.
PROPERTY OWNED BV CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
Sign e f imani
. hereby certiry the above statements are We, correct and complete.
Address (number and street, city, stare, ZIP code)
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediatery (��
surrounding residential improvements.
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residentlal improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 Ihrough line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby teRify ihe abOVe is true, correCt, and Signature oi Assesor Date signed
complete.
Verilying action - Signature ot Auditor Date siqned
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead $
Valuation or 52,000
SignaWre of Audimr Date signed