Homestead_Ritz STATE FORM 53569(RIVE-09) TREASURER FORM TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS,220D9 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE ICS-I.I22-8.1
• 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
•auses higher tax bills for all; therefore, HEA 1344-2099 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.
PART1: PROPERTY F'FOR:MATION
Taxpayer Name Property Address State Parcel Number Legal Description:
Bennett C Ritz 400 S Victor 26-18-24-201-000.480-026/ 011-00480-00 LAGRANGE ENLG
FORT BRANCH IN 47648 215 PT
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2:TAXPAYER 1,NFOR\IATION
Owner 1 Last
R elf/Ai/27r Fist �r middle s
Mating Address(mater and street oily,state and ZIP cede) I ,Sarre as property address
1/4'9 S. V/cToA 57 F reA4-/Ue/f
Spouse First Middle Last
Mailing Address(meter and street.city.state and ZIP code) Same as Property address
Social Security Nunter(last 5 digits) Drivers License State ID Hunter(last 5 digits) state Other(please specify in Pad 4 below)
— — — — BART-'3::GERT►FICATION_ -
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 TAX
CREDIT/STANDARD DEDUCTION
S�ate Fortn 5473 (R6 / 4-03)
PreStribed by Ne DeOartment of Local Govemment Finance
INSTRUCTIONS: See reversc side /or /iling inslrucfions.
FORM
HC10
YEAR
��e) �� certify�th�}al,on� e 1s/t,�d�a of March, 20
I(We) occupied as our principal place of residence the foliowing de ed real property (or which a Homestea�Prbpert}�T� Gredi�is hereby daimed:
❑ I(VJe) owned ❑ Are buying under wntracl ///� �`jn!( ///�
� Have a benefidal interest in fhe enGty that is liable for the property taxes on Ne pmperty and that ov¢is f�_e�p�o�oyis'�bLqirtg�uUCAr � nVaU.
/tT n�ocnti r°n�it,lTY AUDI70R I
If Auying om m�Vad, Fee Simple owners name
mntraU is recorded
County
ra�msnlp
U I I-bC��B � -OD ��JZQ/�lii-
N any portion of the residential sW cWre w tha land not exceedinp one aae that
af Ne property util'¢ed to produce ifxome.
Record number
Tating
Page
S�� �Real propeM ❑ Mobile Homo (LC. 6f.f-�
surtounds that sWClure is usad b Droduce income, describe Na use and portion