HomeMy WebLinkAboutHomestead_Leathem STATE FORM S3S69(R31S-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1 2_2-8.I
IMPORTANT NOTICE TO,HOMESTEAD PROPERTY OWNERS +: » 1
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.
n a PARTI: PROPERTY INFORMATION '' 'T^t'-: *w?
Taspas'er Name proper'h Addrest State Parcel Number Leal Description:
Kevin W Leathern 506 S CENTER ST 26-19-19-101-000.565-026 PRITCHETTS ADD 25025IPT
FT BRANCH IN 47648
Complete and return to: I10IIUUJUfuJaEU]QEl1 NIU lLMOL11ODu119®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 U IIJ
c • PART 2: TAXPAYER INFORMATION 'r:_
Own r I First Middle Last
EVIL ) 1/AI Al oe LEAS OEM
Matting Address(number and street city,state and ZIP code)
171 Same as property address
Spouse First Middle Last
I14./oREil N L Ell r 7n
Main;Address(camber and street,tidy,state and ZIP code)
IN 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 1 Si ature Date
^' is �.p'°. .` �,:5.'" ':':� ft+�, r v. y
FILED
•
• Nov 8 2012
01DSON COUNTY AUDITOR
, ' CLAIM FORNOMESTEAD P.ROPERTY TAX
CREDIT/STANDARD DEDUCTION
t Siate fwm 5673 (R614-03) .
" Preacribed by the Department of Local Govemment Finance
� INSTRUCTIONS: See reverse side lor filing instrvcUons.
FORM YEAR
HC10
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��B) 4 ceNfy Nal on the tsi day ot.March, 20_
I(4Ve) occupied as our prindpal place oi residence the following described real property for which a Homestead Property T�c Credit is hereby daimed:
�1(We) owned ❑ Ne buying under contrea �
Have e benefidal inierest in the entiry Nat is liable for Ne property taxes on the property and ihat owns Ne property or is buying under a conVect.
If buying on contrep, Fea Simple awnafs name
Recordefe ofica where conVap Is recarded
Counry
num
eKripGOn Is ihe
o►�-6a5���-� n���9,� ��aa
tl eny portion of Ne residenUal structure or Ne IaM not axceeding one (7) aae Ihat unmediatey surtounGs
of Ne property W7ized to produce incama.
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Rewrd number
Paga
town. towns )
l
�perty in puasllon:
�Real property ❑ Mo6�e Home (I.C. G7.7-n
t sWGUra is used lo produce incoma, describe Ne use and pwtion
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, "� g��ASSESSOR'USE ONLY`-F�i �� " TRUE?A7�(�g,�� - ASSESSED�VALUE ,�fiHOMESTEAD 4 �� � NOtJ�RE3IDENTIAL F ���
���s+�'-�'�...rt.6;>�,...9e�+.�iv'�:��•�.rF�x'2�..- 's=��i ��SVALUEi?,'F",�".t, >'AT_i100%OF.eTfY.� �.�V/LLUE;�_' RZ�`w.�a-.VALUE?':'�,,.�,c F;.r.
surrounding r�esddanUalmprovveem,e^�ediatey . ��� - = - F ,5°.��w �� 5���'.�` `s �=�
Other land �y� � ' !.:µx .rc`.�
T�al IarW (Ilne 1 plus line 2) �3�
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Residential improvemenLS or MnuaAy �����9 �4� :�s�+-s'� }'�� a�+�' i�� ��
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Pssessed Mobfle I Manufactured Home _`�.� rN ^?+�= � F�-+�+ w,y� s
Gare e �
9 �5� k'.��.�.:.r=�i»Rr�:i:' ^3�, �;,
':i x y.. �n�
O�qei improvements (6) , ,
TUaI improvements (line 4 thiough li�re 6) �7�
Tctal value (line 3 plrs line � �g�
I hereby certify Ne above is true, correcl, and � Signatura otASSessor Date sipned
complete.
Verifying eWon - SignaNre of Fwditw Da[e signed
`"o'%µ F .i -...�Ff•yt f. .' Y � . t J l � ' . _. s . ' � � '. h . . .w . , � .
t 'y _G.�, ._;�_� �t�t��JSTANDARD:DEDUCTION'ACLOWANCEw •
20_Pay20_ .
Lesser of 12 Homestead
Valuation w $35,000 S
SlgneNreaflwditor Date ned
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