HomeMy WebLinkAboutHomestead_Norris SLATE FORM 53569(92e-09) TREASURER FORM TSIAI•
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.I-12-s.I
-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
s 'auses higher tax bills for all; therefore, HEA 1344-2099 requires taxpayers who receive the homestead
andard 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.
. PAR l: PROPER 1' :`FORMA ION
Tasoarer Name Property Address State Parcel Number Lent Description:
Jack E Norris 507 N Main 26-18-13-402-000.830-026 011-00830-00 PT SE 13-3-11 .50 AC
Fort Branch IN 47648 ✓
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2:TAXPAYER INFORMATION
Ovpert First Middle Last
Jel.c ill elar7 AlerriS
Maduq Address(punter and street dry.state and ZIP code) HT-re as property address
Sol N 214 Pt'
o,.wse First Middle Last
Mailing Address(nurrter and street city,state and ZIP code)
Same as progeny address •
•
Social Security Hurter(last 5 digits) Drivers License State ID Hunter(last 5 digits) sate Other(please specify in Part 4 below)
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
( )
PART 4: ADDITIONAL INFORMATION
•
, CLAIM FOR HOMESTEAD PROPERTY iAX
CREDIT/STANDARD DEDUCTION
`�/) 5�aicF�xm�4�9IR6/4-03) ,. �
Prescri6cW by t�e Department o( Local Govemm_ni Financ< '
INSTRUC ilONS: See revcrsc side /ar (iliny inslrucfi��ns
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APR 2 5 2005
.•,�'" i-Y�.°;t;:,* < . . t:t '. �+- '; ,<l:tK11hIGAlION SIAIEMENT'. y',..•, r. , . ' p. . .� . _. �
I(We) ,'-�6��\ � T �� certify that on t�����,�'oR4}�idFY, 2CUDITOR
I(We) occupied as ou principal place re 'dence the following described real property for which a Homestead Property T�e Credit is hereby daimed:
�(We) owned ❑ . Me buying under coniract � � � �
`� ave a benefidal interest in the enfity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
If buying on tontraU, Fee Simple owners name
Recordefs ofice where contract is remrde0 Record number , Page
'`y'S"� � '� �� � `' '='`' � _"-?':`?PROPERT.Y.�ESCRIPTION.,� .
-- "., - z.. ,-._,: ,.. . . . .
Cotmty Township Tacing disirict (city, own, township)
Parcel number /�p 1 Legal tlescnption Is the D�oPerty in puestion:
�_�_\ '� V_p,v�_�O � D�oOaMY ❑ M1lubila Homo Q.C. 67.:-7)
II any portion ol Ne resiJential strucWra a Me and not exceeding one (1) aae that immeAiately wrrounds thai sw ure is usea to D��uce inmme. desvibe Ue uu antl ponbn
of ;ha propert/ u5lized to produce inmme.
':s'`„ '-'.�.-.A;� �d-`'�r. :J' �.;�:�,�PROPERIY:OYVNED'BYCLAIMANT�IN!OTHER'COUNTIES �;. - w - " W-�� ��: �
County `TO.vnship Counly •Tavnship
I hereby cerOfy ihe above statemenls are W e, coned and complete. i ture ol claimant
��%� I.(%eir� � / !
�7dress (number arM sVeeC ciry, sfafe. ZIP code)
" SO% /!J /�'/4� F..Fll�a.�c� I �i%li
, . ,� -- - .. ,.
g+1_,.,r-�'' � ` �'��`'�T �r�'"r��(4f�.G`�' �tTRUETAX ` �:ASSES$EDV/LLUEi'HOMESTEAD-'�= a�..NON-RESIDENTIAL' ����
sf,.'Y2.§c'3Y�'� `ASSESSOR USE.� Y"`'c.,� �+'�q: *`,r�i�'S a�°.r3 VALUE,�, •�,,�: AT 100/ �.OF'TTV ^ � VALUE.� : 3"T.,�. e: ,�_VALUE`` � ••-f4 ;.''i
o 'T � v �
�.� . ..�.. ..�a..�. - _� ..
Land not exceeding 1 (onej acre immediately � �t `� +�" v '+�a_-' � � � �
surrounding residentlal impravemenls. (�) ">i¢ ?r".'� �= 's. ,,.�. . ',.,
r{.;—.' • .ri" _
Olher �and (Z) � x x�"',�,� ' - -
. t �,�T'�,:,: _ -
TUaI Iand (line 7 plus line 2) (3�
Dwelling (4) ,y ,�`� '�t - ' 7 ..
ResidentialimprovementswMnually . ' �� ^"z`'��'°'—���--""
Assessed Mobile I Manufacwred Home Garage (5) -.c-'°'+?^`�"'�2� '*`;c y�.e%. � a�'
s�} ' _w r:2c*_.': -. .�.�.�_, •: .
ONer improvements (5) � `1 `'� ` u .
."t ��_-!, .�.�.
Total improvements (line 4 through line 6) (�� �
T�al value (line 3 plta line n (g�
I hereby certify the above is We, cqrred, and Synature o(ASSessor Date signea
complele.
Veri(ying action - Sfgnawre oflwditor Date sgnetl