HomeMy WebLinkAboutHomestead_Looman STATE.FO (AMMO)5f5156 (AMMO) TREASURER FORM TS-IA
APRROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1--22-5.1
ig IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNER .; `�"t
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
duction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
o
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.
.,.,^- d'ARTIi'PROPERTY.INFORMATION - ,_>_A .%,e;. , " n
Tasoaver Name Property Address State Parcel Number Leeal Description:
Sean Looman 7865 S 45 W/SHAWNEE DRIVE 26-19-19-204-001.302-026 INDIAN HILLS 64
FORT BRANCH IN 47648 (gyp `1q j'1�{y p�I ,dt;;�� ��'5''iitt�'y9ffj f1lI((��{{�� fnf'�f fIl�i�f�;j Ip(1 Ig1,�I
Cnnzplete and return to: iiiiiiiIll0111RI JiLUiti111111DTIL111.1111lOIW 11.111.�UIIII
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
R •;.>4; . H. PART 2: TAXPAYER INFORMATION 'y
Owner I . First Middle �� Last
eet et Mailing Address(number and street city,state and ZIP code) Same as property address
7165- s yst-
Last
Mailing Address(number and street,city,state and ZIP=de) Same as properly address
Social Security Number(last 5 digits) Drivels License/State ID Number(last 5 digits) Sure Other(please specify in Pan 4 below)
. ---11.44-+'C' ,:"7 - PMI :3 C-ER14FIEATI ::c.. ., .- -e=^" ,.irk.rq,�
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 tw Date /2 Teleptame
— —/ �/ - 2O / 2 (
F .• DEC 1 ¢ 2012 /�
c.�.n V
G16btm COUNTY n11n1TOR
�: � CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� State Fwm 5473 (R6I1-03)
PrescribeA' -Ne Mpariment ol Local Govemmen� Finance
W�� �: See ievcrsc sidc for Iilinq insliuc(ions
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FORM
HC10
YEAR
� /j� �� 11n!
I(We) _ //��/� � cerh�yPlha t on the!isUCay of March, 20
P
I(We) occupied as our principal place of residence e fo owing desuibed real property for which a Horriestead Property T�a[c�Credit is hereby daimed:
❑ I(VJe) owned ❑ Are buying under contract � � �— 7��/ f//J
' Have a beneficial interest in ihe enfity that is liable (or the property taxes on the property and tliat owris'�lhe p�rty;b r, i sbuyi "�und e r a wnVact.
If byvg on conirad, Fee Simple owners name
Recorders oifice where conUaq is remrded
Toxnship
racing aistrict (riry, town,
the
portion at Me residmtial sWaure w Ne land not exceedinp ona (1) aae ihal immediateN wrrounds that
property uUlized tn produce inmme.
Counly
I hereby ceAify the above statements are We, corted and complete.
ciry; stafe, ZIP code)
�
County
Record number � Paqe
Real D�aDertY ❑ Mobile Homo (I.C. 67.1-�
va is used to produce income, tlesaibe Ne use and portion
�T �� ' ��'��1�'"'���`�`� z �£ :'�'TRUEvTAX � � ASSESSED VALUE '�?HOMESTEAD r"' �NON�-RES�DENTUIL`"��
��''���A�S�ESSOR USE ONLY� �� ,,3: k`�' VALUE�;�Rt '" � �/1T.100%'OFTTV � ''%VAI?UE� ��-.u.`�"`•`VALUE`�' ���3 -a'
a.'r. 1k'rc�...,_ =al.»�-i5'�3•.��.��`�3.�1 ��w .�� sY s�?CF�- �eT a `.'-iy,..� �_€.,.,�3'. ��
Land not exceeding 1(one) aae immediately ��"j�?�"� " �� ��
surroundingresidentialimprovements. (�) '�`�'����`:�������e T�;Y��
,Q..� y , s.�3.�{'3.� �-+��3-�
Other land . �2� -�,�i"���.�'�'���� �� �
-•`:-���=k�`.!�,.�A�
TUaI land (line 7 plus line 2) (3)
� �aa,t-u�� r€ '�� �- �
Dwelling (4) "a s''�� ;!}i H "`-}
Residential improvements or Mnuaily r�^�'���� ���"�^"��
Assessed Moble / Manutactured Hwne Garage 5 �y'^� `;7y`- T� .�-'^.��
( ) :�, f�. � .t�
-�3vi�_'Ky:.'S%`��-`�= nc�i
Other impmvements � (6) �=-^'-� �
�'�i��"�.�
Tdal improvemenis (line 4 through line 6) ���
Tdal value (line 3 ph.s line � �g�
I hereby certify �he above is We, coved, and Sgnamre ofASSeswr Date signed
complete.
Veri(ying adion - Sigfature oflwdimr Date signed
.�1 T' N .' �1 ��