Homestead_Monroe ,STATE FORM 53569(R3/13l0) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-l.l--22-8.1
"144, i1MPORTNNT NOTICE TO!HOMESTE'AD-PROPER<TY OWNERS ' 'e
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
+eduction 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.
Y c; PA'i I: PROPERTY INFO'MA ION '
Tasisaver Name Pro nertr Address State Parcel Number Leal Description:
Mark A Monroe 601 E STRAIN ST 26-19-19-101-000.533-026 EASTVIEW 23
FT BRANCH IN 47648
Complete and return to: 11111 11M1:1
say Cy GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
,1 ' x:11 a��.. 4�., ,4. s s - , e . 0 i tl - ..
uOwner 1 First ' Middle Last
fitAi k- /i2o/vgo c .
Mailing Address(number and street,city,state and ZIP code)
Same as property address
60/ E. STRAw/v ST. Fop BRA 9vet+ U, y76oVa-
bpouse First Middle Last
Mailing Address(number and street,city,state and ZIP code)
- Same as properly address
Social Security Number(last 5 digits) Drivers License/State ID Number(last 5 digits) state Other(please specify in Part 4 below)
PA'T3: G RTIFIGATION
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
( )
' " -"T'''r4-Z-r 's�;i PART 4: ADDITIONAL INFORMATION .4- ' -
FILED
JAN 3'1 cm
N COUNTY AUDITOR
ed "h°s CLAIM FOR HOMESTEAD PROPERTY TAX � FoRM YEAR
i��': CREDIT/STANDARD DEDUCTION HCiO
�.. . ��,,��� Sta;e Form Sa73 (R2 / 5-92)
,.'• - . . _� �..�
INSTRUCTIONS: See reverse side lor /iling instructions.
� �� - CEHTIFlCATION STATEMENT - - ' +� �— �
��" e) ��.jL. /� �� I ^ certify Ihat oM1 lne 7 st day ot March, 79_
�) occupied as our principal piace of residence the tollowing described reai�property for�which a Homestead Prop/e�rty Ta�c Cre rt is reby Smed:
❑ I (We) owned .0 Are buying under contract . � � • ""' � " eUp TO�
❑ Have a beneficial inierest in the entity that is liable for the property taxes on the property and that owns the property or is"buymg under a contract.
-0ONTRACTRECORDED . - �
II1 buyinq on convact, Fee Simple owner's name�. '. . .
Rewrder's oifice where contraa is recorded Record number Page
PROPERTY DESCRIPTION
County - - Township . ` _ . � Tazing district (ciry; town, fownshlp) . �
Parcel number Leqal tlescription -
1` o533-Ea �
It any portion of the residen6al simcWre or ihe IaM not exceeding one (7) acre that immediatety surmunds Nat siru..,.. e is used ro protluce income, aescribe ihe use and portion
of the property ulilized to prOduCe intome.
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land noi exceeding 7(one) acre immediately ,
surrounding residential improvements. (�)
Otherland (2)
Total land (line 7 plus line 2� (3)
Dwelling (4)
Residential improvemenis
Garage (5) � -
Oiher improvements (6)
To�al improvemenis (line 4 through line � (7)
Total value (line 3 pUs line 7� (g)
I hereby tertify Ihe above i5 �me, CArBCi, and Signature ot Assessor Date signetl
complete.
�tying action - SignaNre of Auditor Date signed
19_Pay79_
Lesser of 7/2 Homestead
Valuation or S2.000
DEDUCTION ALI.OWANCE
S
Signawre oi Autli;oY� `� . . ^ ^ . . I "°„T�l•_ / _
i � v