Homestead_Hurt (6) STATE FORM 53569(RIB-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.1009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.I 12-B.I
' IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS, r .
, -W :
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.
MOWS t _ PARTI-PROPERTY INFORMATION , :A•.* ,P as"i `.=
Taspaver Name Propem'Address State Parcel Number
Letal Description-
801
Rock/Monica Hurt E SINCLAIR ST • 26-19-18-302-000.653-026 HILLCREST 29
FT BRANCH IN 47648
Complete and return to: 1111111110!IAIIII:IIIlllllll�IIMM1EM1][311G119TI[IJIDIIII
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
V:- 1.7 _ PART 2: TAXPAYER INFORMATION i °c'v` r. '=4
°(�1 First Middle '1 Last
1\C7Lf I— Mai
-
Mailing Address(number and street.city,state and ZIP code) /same as property address
201 C. Sinc(a,r j�Urf l3'a..(.4 ,....t___Ai Li7Coe7`ax
-
sbouse First - -_ • Middle Last
Mailing Address(number and street,city,state and ZIP cede) I <Same as
properly address
KO 1 E Skid-cc,- rorf 2112r•C`t `f 96 Y$
: .c:� i
i r -_ + . a wT -v
5�#
rer...a -: iaa.�e•c a-9A;.. J.Y___ __ _ 4
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
° - - ,'[* v " °s `
• .. FI ED -
NOV 9 2012
' GIBSON COUNTY AUDITOR
„,.^•�.
a� �” i CLAIM FOR HOMESTEAD PROPERTY TAX
3E�': CREDIT/STANDARD DEDUCTION
� � � State Form 5:73 (R2 / 592)
yu
INSTRUCTIONS: See reverse side !or liling insVUCtions.
�--- — --� �. �_
FORM EAR
HC10
�(W � Z-� V. �� µ� V l . certify that oruh�i st day of March, 19
I(We) occu ' as our principa place of residence�ihelollo ing described �ealproperty for which a Homestead�PropertY}��c� (�e is �q�ed:
� tl 0 11
I(We) owned ❑ Are buying under contraci - g � q_ q
��lave a beneficial interest in ihe eniity thai is liable for the property taxes on the pmperty and that owns the property or i{��yXipg�un�e;�c�o�tract.
. CONTRACT RECORDED �
If buying on contract, Fee Simple owner's name _ .. ." � .` . A1 t D ITOp
U I f�
flecortler's ottice where contract is reCOrded Record number Paqe
County
_ , � TownShip
Legal description
If any portion of the residential sVUCWre or ihe land not exceeding one (1 � acre �hat irrlmediatety surrounds �hat
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER
County
Township
I hereby certify the above statements are ime, correct and complete.
,�'cess (numberandsbeef, ciry, s7ate. ZlPwde)
usetl to produce income, describe Ne use antl portion
ASSESSOR USE ONLV - TRUE TAX. ASSESSED MOMESTEAD NON•RESIDENTIAL �
VALUE� VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately . �
surroundin9 resideniial improvemenis. (� % � � �
Otherland (p) �
I
Total land (line 1 plus line Z� (3)
Dwelling (a) _ �
Resideniial improvements
Garage (5)
Oiher improvemenis (6)
Total improvements (line 4 through lina � (7)
Total value (line 3 p�s line 7� (g)
I hereby certify ihe above is �rue, torreCt. and Signature ot Assessor _ Date signed
complete.
Verityirg action - Signamre of Auditor Date signed
79_Pay19_
Lesser of 7/2 Homestead
Valuation or 52.000
DEDUCTION ALLOWANCE �
�
Signature ot di;or � 4 \ � V' �� I Date/sig�ed � ��
��_�� hd S J �
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