Homestead_Sevier STATE F9R.M 53569(R3/5-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,3009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.I-22-8 I
: IMPORTANT NOTICE TO HOMESTEAD PROPERTY,OWNERSr '
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.
9: ; _ t.0 PARTI: :PROPERTY INFORMATION " 5
Tasna'er Name Property Address State Parcel Number Lena!Description:
Jeffrey A/Rhonda S Sevier 4682 S 87$E 26-20-03-100-000.119-001 NE NW 3 3 9 36.464 AC
OAKLAND CITY IN 47660
Complete and return to: IIIlIIftIIJUIIID[II[DDhI13I IUIIU11➢I[DUll[11101l]f!UIUII
C13SON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
;r', PART 2: TAXPAYER iNFORhIAT10N
Owner 1 First Middle Last
igeiMo 4Y ge_sa er
Marling Address(number and sweet,city,state and ZIP code) ri(�a
me as property address
Z/(9 2a5 8-751; (90e04c/6-A v 54766 0
•
spouse First Middle Last
C9/7_64 ces-a4 ewer
Mailing 6tl �(numbera?75:6' 92e(CYd ( 4 / N cf d Same as property address
M 3 , w a@=.` i t+rk;' ,yPAR 3:;CE ' IFICA ION '1+',�� { l I° .` a-h.�a.uWE �3 <
.G�.
Each undersigned certifies.under penalty of penury.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 Sig Date
�4r • a:*` ` "PART 4 ADDITIONAL 1M RMATION
s-..e. a_ �{ .�-.s�`•. Pp. a.a!n'a-+sre'�F4' At.��.. i� ,...... ..�.._ . _.. ..,Y«.�.ATM
•
FILED
NOV 7 2012
GIBSON COUNTY AUDITOR 1r
I - CERTIFICATIONS STATEMENT - I
A , i I - ) f na(A V • —V—Af � certify that on the 1 st day of March, 19
place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACT RECORDED
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
CLAIM FOR HOMESTEAD PROPERTY TAX
P.
- FORM I
R
•
}
CREDIT /STANDARD DEDUCTION
HC10R4 9
�
.,,;
Slate Form 5473 (R2 / 5 -92)
Other land
(2)
Date signed /1
INSTRUCTIONS: See reverse side for filing instructions.
. IiPiy& . A7
I - CERTIFICATIONS STATEMENT - I
A , i I - ) f na(A V • —V—Af � certify that on the 1 st day of March, 19
place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACT RECORDED
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
PROPERTY DESCRIPTION
County
Township I
Taxing district (city, town, township) -
Parcel number
0oI- oopts =oo
Legal descri ion
t ►JLJ 3- g3.70 b-c-
It any portion of the r at structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income. describe the use and portion
of the property utilize ce income. n 1
\Valuation or S2,000
r� _
Other land
(2)
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
eby certify the above statements are true, correct and complete.
a, re ai ,
ess (num a street ty, state. Z code)
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
\Valuation or S2,000
S
Other land
(2)
Date signed /1
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pUs line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
nrg action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19 _Pay 19_
Lesser of 1l2 Homestead
\Valuation or S2,000
S
Signature of Auditor
Date signed /1