Homestead_Land STATE FORM!!!MIR:I!-W1 TREASURER FORM TS-TA
APPROVED BY MATE KURD Of.MTY4%TA IDV PRESCRIBEDBY mr DEPARTMENT IF URAL GOVERNMENT FINANCE IC 6-1.1-2:-A.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples.are limited to one homestead standard deduction.As the receipt of this deduction becomes
mole beneficial.there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all:therefore. ri
HEA 1344-2009 requires taxpayers who receive the hotnestead standard deduction to verify that they are eligible to recene the//'t}rJyy~
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kepi conlidemial and can only be accessed by authorized county officials The Depanmenl of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY LNFORMATION
Taxpayer Name Property Address
Land, Kim 0/Lora L
906 Mohawk DR
Fort Branch IN 47648
7616
Kim 0 Land
906 Mohawk Dr State Parcel Number Legal Description
Ft. Branch IN 47648-9508
I I II III I II III I I II I III II III 26-19-18-101-001.147-026 /011-01147-00 LITTLE YORK V11_PHASE II
t o nt t nt n n t t nt t t ru n t nu nu t 2 D-27
PART 2:TAXPAYER INFORMATION
Owner I First /'/Mii�ddle / Last
K i ti\ V. k. c and
ng Address(number and street,city,state,and ZIP code) - - - - -IN Same as property Bddress - -- — — . — —
Spouse First Middle / Last r �. kand
Mailing Address(Number and street,city,state,and ZIP code) ®Same as property address
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) Signatur I Date
0
�� � CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
6 � State Fwm 5473 (R4 / &00)
u�.
' INSTRUCTIONS: See reverse side (or filing insWctions.
FORM Y R
Hc,o � o b�.
i�we� ►� vv` cey� ma�� i�5i �M a, o
I(We pied�as our principal place o residence the following desuibed real property for which a Homestead Property Tac Credit is here y daimed:
I(We) owned ❑ Are buying urWer contract � N O V 1 5 ZOO�
.Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns tl�property or is buyjng under a conVact.
11 Duyinp on conVad, Fee Simpte owners name
Remrders olfice where contraq is recorded
Twnship
Legal tlescription
u
Tadng disViU (cN};
Record number � Page
If any poNOn ol the residen6al sW clure or the tand not exceeding one (1) acre Nat immediatety surtounds ttial structure is used ro produce inmme, describe Me use anE poAion
ol the property util¢etl to protluce income. � - � •
I hereby certify fhe above statements are We, correc[ and complete.
j7reu (numbuandstreeC ciry. state. ZlPCOde) ,, _ �
Land not exceeding 1(one) acre unmediatety
surrounding residential improvements.
Otherland
Tdal land (Irne 1 plus line 2)
Dwelling
Residential improvements
Garege
Other improvements
Tdal improvements (line 4 fh�ough line �
Totat value (Gne 3 phs line �
I hereby certiry the above is We, corteG, and
complete.
Verirying aUion - SignaNre ollwdiror
(�)
(2)
(3)
(4)
(5)
(6)
(�1
i8)
Signature of Pssessor
County
al
Date signetl
Date siBnetl
� ,�,,,��:,,, ` � �-'"�'�;���„�';��-;��z�STANDARD���DEDUCTION�AL.L'OVNANCE�`�"�,-,_,K� ���`-�''=��,��;,�:� ,�`��?�`� w�
20 _ Pay 20 _
Lesser of 12 Homestead
Valuation or $6,000 $
SignaWre ollwditor Date siqnetl