Homestead_Moorman - STATE FORM 53569(NIB-It) TIOASURFR FORM TS-IA
APPROVED BY SUE BOARD OF MLUUYIS.]LM •RESCR1BFD BY THE DEPARTMENT OF IMALGO%EY\MEYT FtNAVLE ICb1.1-y-0.I
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N.Main Street Individuals and married couples an limited to one homestead standard deduction.As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial,there is more incentive than ever for homestead Lauri 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
T Ti benefit and to provide additional identifying information nttrssary to allow county government to better monitor homestead
1 /L, filings.This information will be kept confidential and can only be accessed by authorized county officials.Thc Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART l: PROPERTY INFORMATION
APR 8 2011 Taxpayer Name - Location Address•
C,�, , Moorman, Amanda K
7982 S 40 E ,
GIBBON COUNTY AUDITOR - FORT BRANCH IN 47648
2656 .
Amanda K Moorman ' II inn oIII_[III 1111111101111011111111 II 0II1II_III 1111111NI_I I_DII1111011I�III
7982540E
Fort Branch IN 47648-8016 '
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII State Parcel Number Legal Description
26-19-19-204-001.335-026 'INDIAN HILLS 105 D-27
—
This form MUST be returned to County Auditor's office. -
Please do NOT send this font back with your tax payment to the county treasurer.
- - PART 2:TAXPAYER INFOIL\L4TION
Owner t First , Middle - - Last
A rn an(9,A, _ Kay ° M oorrlah
Mailing Address(number and street,city.state,and ZIP code) - Il Same as property address•
n g g a S 9 0 L Eor4- av'anal ` -i--_Ir1 , y7(a`/S '
Spouse - , First Middle Last
- , `
MailatA idress(Niunbe arsfrcct,city;state:ind ZIP cede) -= ="""--;- --. f-Sardc is Noperty address --
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
I I ._I-_I--__ 1 i I-1— I sou
PART 3: CERTIFICATION
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. .-
OwDer I Signature Date
• -
�
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDR/STANDARD DEDUCTION
t state Fam 5473 (R7 � sa�
Prescri6ed by the Depertrt�ant ot Lool Gwemrr�nt Fvance
INSTRUCTIONS: See raverse side (w fiiing insbucfions.
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FORAA
HC10
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�(we) c�t // ��.vY�� /' L«� r l(�(/ {'�� certity tnat on tne �� daY ot Magfi}�{p
I(We) ocaipied as our prindpal place of reside�ce fhe fo�wirg desaibed real property for which a Hanestead Property Tmc Credit is hereby'ti�
�� (We) owr�ed ❑ Are buying under mntract .��
rlave a berefidal interes[ in ihe enti that is liade for Me taxes m tl�e ���"'
ty propeAy property and ihat o.ms the property ar is Wy"vig under a can�avcl
tt G+Y'vi8 om m�traq. Fee Sirr�le avmefs narre
' = i: '_...... . � _.... : .
Camty Tuvr¢fdp Tmmig disfricl (cCy, fown,
Pa�tel rvimber LeBal deacriPlian I Is Ihe properry
H anP Pamn of the rasidenlial struWaa a Ure Imd rwl occeedirg one (1) ava ttat unmadatey wnwnds Ihaf
d U�e praperty tN6md b proMCe uiwne.
Recard number � Page
Question- �
iael property ❑ MoEila Fbrtre (LC. 61.1•n
re ia usatl tn pmduce 6wDma. tlexribe Uia usa end portion
20 _ Pay 20 _
Lesser of 12 Homestead
Valuatim m 535,000
5
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