Homestead_Gill STATE FORM 53569(R2/8-09) TREASURER FORM TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 105-1.1-22-5.1
1111,WORTANT OTI@E TO HO ' +1STE+AD PROPERTY (MIND C
•
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
se..ndard 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.
AR- I. • OP e _ . N ORN ION
Taspaser Name Propenv Address State Parcel Number Lent Description:
Michael B Gill 601 E Locust 26-19-I8-303-000388-02," EASTVIEW 3IPT/32PT
Fort Branch IN 47648
Complete and return to: f®hIHDId1111110HQQ®ftll®I11 m111lD1111.1m01U1111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
glk,MS3M2IIIIZ22
Owner 1 Fast Middle / Last
,1,�/A J��/—1
Mang Address(number and street,city.state and ZIP coda)
Same as property address
1o,6 4'- ><O stn- ■ t StY
/
.e First Middle Last
Maine Address(number and street,city,state are ZIP code) Sane as property address
Social Security Number(last 5 digits) Dr'iver's License State ID Number(last 5 digits) Sae Other(please specify in Pen 4 below)
PATitrat COMM= ION :.
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 Signature Date
PARTS 0 2JQ QTION FILED
• MAR 2 5 7011
4GIBSQN.COUNTY AUDITOR
'�ST•"° CLAIM FOR HOMESTEAD PROPERTY TAX
i �� CREDIT/STANDARD DEDUCTION
.
���i' SWte Fortn 5473 (R2 / S92)
_ �
INSTRUCTIONS: See reverse side lor �ling instructions.
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APR 0 y Z001
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CERTIFICATION STATEMENT
�(we) � certi at��FiRN�@d�`bTis#M�h?��9R
I(We) xcupied as our princi al place residence the following described real property for which a Homestead Property Taz Credit is hereby claimed:
�(We) owned ❑ Are buying under contract - � -
Have a benefcial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a coniract.
� CONTRACTRECORDED � - '
If buying on conVact, Fee Simple owners name
RecorCers office where contract is recorded . Recortl number Page
PROPERTY DESCRIPTION
Counry Township , Ta�dnq di51ri ry, rown, fownship)
Parcel number Legal tlescription �
—c7U
It any ponion ot the resitlential siruc[ure or the land not exceeding one (1) acre that immetliarey surtounds thai stmcture is used ro produce income, descnbe the use and ponion of
ihe properry utilizetl ro protluce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Townsltip Counry Township
SignaWre of ai nt
ereby certify the above statemenis are true, correct and complete. �-5 . 0/1
,(iC.V
Atldress (numberandsVEef. ary. sfd7e, ZIP Code)
�
r. c T
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding 1(one) acre immediately �� � �
surrounding residential improvements.
Otherland (2) �
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvemenis (6) -
Total improvemenis Qine 4 through line 6J (7)
Total value (line 3 plus line 7J (B)
I hereby certify the above is We, correct, and Signamre of Assesor Date siqned
complete.
Verityinq action - Signature of Autlitor Date signetl
STANDARD DEDUCTION ALLOWANCE
" 19_ Pay 19 _
Lesser of 1/2 Homestead S �
Valuation or 52.000
SignaNre of Autlita Date signed
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