Homestead_Small 'STATE FORM 53569(8215-09) TREASURER FORM TS-I Al
APPROVED BY STATE BOARD OF ACCOUNTS.2009 • PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1-22-8.1
.
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•
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 1344-2009 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
I will be kept confidential and can only be accessed by authorized county officials. The Department of Local
l Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
lr3Y$1t16 lR, i$R`(INFO'M '0tLfl1
Taspaver Name Property Address State Parcel Number Legal Description:
John C/Kathleen Small 407 N Church 26-18-13-402-000.736-026/ HICKROD ADD 5
I Fort Branch IN 47648 ✓
Complete and return to: IIOIUU][VDB®UIl I UILOIIU M tMUDIDF1If®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART? 144 VZ131NFORMATION .
Owner I Fast Middle Last
3_9AAh 6. .dimes- I i
Mang Address(rvnber and street,city,state and ZiP code)
Same as properly address
_-s First Middle Last
Ko , leen San SW.ai1
Maine Address(number and sheet,ciy,state and ZIP code) �ame as property address
•
I
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
• , PARTa TION
FILED
MAY 202011
rc " V
GIBBON L.uuotTT AUDITOR
POPM HL 10 1W9 �- 10 Be FileO in Uuplica�B
PreStti�e4 By $�aie BoarO o� iaR Cammi55ioner5
CLAIM FOR HOMESTEA� PROPERTY TAX CREDIT FOR YEAR 19� ✓
SEE BACK FOR FIIING INSTRUCTIONS Qll-00�3�'0'� �
l
�, (We) � � certify that on the 1st day of
March, 19—, , e occ i d as our principal place of residence the Ilowing described real property for
which a Homestead Property ax Credit is hereby being claimed:
I, (We) ❑ owned �-
O are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in��.__J-t�/,+-a�� Count L�'L�
Taxing District (Ciry, Town, Township): ��.� �t��.�!
Parcel Number or legal description shown on tax
,i ' i. /l � �
If buying on contract:
�ree
.in Recorders Office -
Township
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property:
�hereby certify the above statement is true, correct and comptete.
aveei naoress
County Township
��Y. �a�c v�iu ciV ���C
Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE •ONLY -
Land not exceeding ���@��ra€�ly
surrounding residential improvements
Other Land •a�R `� 9 �Q��
Total Land ,` -° �
Residential Improv entOs AUDITOR
Dwelling
Garage
Total
�Oth r Improvements
Improvements - Line (6) plus (7) equals (8)
I ereby certify the above is true. correct. and complete.
7.�-�°-
Signamre ot Assessar
Approved:
_� -- --
True Cash
Value
(�) a D
(2)
(3)
(4)
(5)
(6)
(�l
(8)
Assessed Homesiead
valuation Valuation
a�o
- ACTION BY AUDITOR -
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Date: ��D -�a/