HomeMy WebLinkAboutHomestead_Mosby STATE FORM S3569(R3/13-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE ICe-IA 22-8.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
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.
•;: PARTFPROPERTY`INFORMATION .
Taspa)er Name Property Address _ State Parcel Number Letal Description:
Christopher!Mosby 101 S WEST ST 26-18-13-403-000.119-026 HOFFMAN ADD I
FT BRANCH IN 47648
Complete and return to: _ - -
I��IIC1611�111(Illi�l��➢Illlf�l&11�I�II[IIIUIQ]III'Iflld- --�
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2 TAXPAYER INFORMATION 'r.' `
Owner 1 First Middle Last
Nte I Marie Nosh y
Ma94g Address(number and street city,state and ZIP code)
t t eaa
O S. vJest S+ Ff • Pr\nci4 property
Spaua First Middle Last
Mailing Address(number and street,city,state and ZIP code) I I Same as property address
Social Security Number(last 5 digits) Drivers License/Sate ID Number(last 5 digits) State Other(please specify in Pan 4 below)
A;. ' .a•°�:.3 T:r : It: r i-,.. PA$T__i•rF�T Ir AT�QN- ..te'm T.• ,. C ::i ..ta °li .n 5rs'mat.cerg" 3_:
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 I Signature Date
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DEC 27 2012
GIBSON COUNTY AUDITOR
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,.''i�'t:7'E7?,.
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sute Fortn 5473 (R2 / S92)
FORM
HC70
YEAR
�� INSTRUCTIONS: See ieverse side !o� (ling instructions. � �� ���� , ��� �_� ��
� I
� CERTIPICATIONSTATEMENT �"� i1'-'"
�re) ^ ertirythatorj�j�stda�oi���h,19_
I(VJe) occupied our princi lace of residence the followi described reai pro erty for a Hom ropehy Tau Credit is he by claimed:
�(We) owned ❑ Are buying under contract . ���� 1���.-�C% J',
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pr �b�i�,� �` under� conlcacL :
� CONTAACTRECORDED
If buying on wntract, Fee Simple owners name
Recorders oHice where contraci is recortletl Record number - Page
PROPERTY DESCRIPTION
Counry Tovmship Taaing distri (dry, town, Immship)
Parcel number Legal tlescription .
� �� C .
Ii any portion of the resitlendal swcture or the la(W rot exceetlinq one (1) acre that immediatey surtounds thai structure is used to produce inwme, describe Ue use anE portion ot
the properry utilizetl to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township � Counry Tovmship
Signature of cl - a
��reby certify the above statements are Irue, correct and complete.
Atltlress (nu ber and sfreet, ciry, sfate ZlP code)
��� ..% � � . �. � � } T� . �
ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON•RESIDENTIAL
VALUE VALUE VALUE VALUE
Land noi exceeding 1(oneJ acre immediately (��
surrounding residential improvements.
Oiherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvemenis
Garage (5)
Other improvements (6) �
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby Certify the above is true, cortect, and Signamre of Assesor Date signed
complete.
Verifying action - Signature of Audiwr Date signed
S7ANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead �
Valuation or S2.000
Signature ot AuCiror Date signed
S- -