Homestead_Obrien STATE FORM 53569(R3l&10) ' TREASURER FORM TS-IA
APPROVED BY'TATS BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 106-i.1-22-6.I
to : . . IMPORTANT NOTICE TO HOMESTEAD PROPERTY.OWNERS ?f
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
.'^duction 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.
^-"+ -r•` '• • PARTI: PROPERTY INFORMATION • ' " =
Taxpayer Name property Address State Parcel Number beat Desolation:
Jerry L/Julie Obrien 7855 S 10 E/MOHICAN . 26-19-19-203-001.227-026 PT NE 19-3-10.426 AC
FORT BRANCH IN 47648
-Completeandreturnto: - IllliittiChtiln01)fERIN:ll�tlllllllllalillll-
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
•R. 1 • - •"11 PART 2: TAXPAYER INFORMATION . " t'' '`_
Owner 1 First Middle Last
c'eae; • ,Lee
C.( rtcn
Mailing Address(number and street,city,state and ZIP code)
Neil Same as prooerty address
796$ a io S, fi 9anchirZ a`e
- .
Spouse • First Middle /'� Last
jIte Ant, dg-te(•
Mailing Address(number and street,city,state and ZIP code) [ #j Same as property address
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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o� ^",
.' t CLAIM FOR HOMESTEAD PROPERTY TAX
� � CREDIT/STANDARD DEDUCTION
` .. � State Farm 5473 (R5170-01)
Prescribed by ihe Deparimem of Local Govemment Finance
INSTRUCTIONS: See 2verse side loi (ling instruc(ions.
l
FORM Y AR
H�,o I� p 6�
ii� Zi �� ;,� —
i(we) �-- l.C..C'/ti certify that oF the�tsi day ��M��cn, zo
I(We) o ied as o rincipal pla residence lhe following described real property for which a Homestead PropertytTat Cretlit is�ltereby daimed:
❑ I ) owned ❑ Are b'ng under contract /y!( ///1 ///�
� Have a benefidal interest in ihe entily that is liable for the property taxes on the pwperty and that owns the�proj�erty�or-i�ying:under;a'contraU.
/✓ r�o�.,.� r^ "
z �s r yZS.-� r.`. b.--1 gr ;z+*.r '�• ,e„_ . . '�.r.3 r 3 � .r+.� - � -: , . _
�---='Fa': r'5,..��;Y''+r.14,,..���ti._x..�r'��F.�'C-��:x�..y?::�-` 5r�.CONTRACT.'RECORDED:�:r,s- _z �:'•'t`F E.tiS+rt.:-.'da 5aF �?�'r'.ns;�.r_.�� ..:•.� '..,_...
If buying am m�trad, Fee Simple ownefs name
Recordefs o1Fce whera cont2d is recorded Record number Pa9e
J l/ �RA� v " —
Parcel num r
' —i
If any poAion of the residenllal
of the ptoperty uWized b prodi
.�?� , /�
Tovnship
Le I e p�i
%
icture w Ne Wnd not exceedir
income.
� /9 ��. � _
Tating dislrict (rity, fown, fownship)
, J� Is the property in question:
� � (J ❑ Real pm0erty ❑ Mobile Homo (I.G E7.1-7)
(1) aue �ha;im ��uno s �hat s4ucture is used to prOduce incame, describe Ihe use anE portion
n
'- O�?C�
�"..�'.. 'xi�.�+t+'��:�-�`Y�.[i,'�'"�xs 4'f' *�- "Y r ..,'l' � ' � o � v .
'�� yA55ES50RUSEONLY� �'�.'�r����.3TRUETAX�,�7i&ASSESSEDVALUE�+HOMESTEAD,�, j�N�ONRESIUENTIAL�r��s
��'�':4����:3��.4 ;�A�47'.�£.��'"�`_.,,x.� f-a�'.�`.�-. 'r�'�i`VALUE'_'" z.,,_ _AT�100%OF�TSV� �i er';VALUE„�..�rt. '��_fi..F^yVALUE'?,��, �2r?_
surtoundingrestldentialomprovements�iately (�� ���'�?��7� �.�� ��',
Other land F���3 jq�r••
�,^� �� �ut
(2) '�t..��-•#�p�..�y-%="�'x?
t-.
Tdal land (line 1 plus line 2) (3�
- T ���'y t s�'r't�;,�� �s,..n
Dwelling (4) y�7't`�'i' s, ; t o ,t 'i,,e�.,
Residentlal improvemenis ��''���''' �`''�'��' SG
Garege (5) ��,4�"���-'_-�'� ,.R.:- :�r',"�'�?:
+.y:`4�; rt'}�$'.1_:`_.,^�' �"=::9�zj=r'v'-
> r'S' '�"�-'�' �?�
Other improvemenls (6) �,�`s�;Ys� , `�. ^,
Tdal improvements Qine 4 through line 6) (7)
Tdal value (line 3 plus line n (g�
I hereby LeAify the above i5 We, corred, and Signature o(ASSessor Date signed
complete.
Vrri(ying action - SignaWre oflwditor Date sgne0
20 _ Pay 20 _
Lesser of 1l2 Homestead
Valuation or $6,000
S
SgnaWre oflwditor � Date signed