Homestead_Will • SIMI FORM M!M tlirIw I ThIASUtLR FORM TS-IA
.ArrRRw'En By SI.StE BARD OFAnni\TS.a% PtI ,1BFDOT TIE orPARnff.`roe LOALtt)vttNMrA'i FINANCE tc &.13:4.l
Gibcori County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 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 eser for homestead fraud.I 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 necec n'to allow county gormment to better monitor homestead
filing-.This information will be kepi confidential and can only he accessed by authorized county officials.The Delanntent of
Local Government Finance will use.this information to create ads that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Will, Theodore S
205 F South
Fort Branch IN 47648
2962
Theodore S Will
205E South State Parcel Number Legal Description
Fort Branch IN 47648-1755
III I I I I III III I I I I III I 26-19-19-103-000.312-026 011-00312-00 LOWES ADD 22 PT/23 PT
to nit utu a tot utt to tr nu t t u t
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
rdiendole 5eot I,Ur l
•ilmg Address(number and stied.city,state,and ZIP code) ® Same as property address
20 St youfh s7` cod 4( rJ if7‘fl
?
Spouse First Middle Last
Mailing Address(Number and stree4 ityNate:and ZIP code) _ ❑ Same as properly addrL a
Social Security Number(last 5 digits) Drivels Lieense/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
sna
PART 3:CERTIFICATION
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 /
e°% "'� ; CLAIM FOR HOMESTEAD PROPERTY TAX
;.E�i� CREDIT/STANDARD DEDUCTION
.�; � State Form 5473 (R2 / 5-92)
�ai�
INSTRUCTIONS: See reverse side lor liling instrucfions.
FORM
HC10
�.�.�
YEAR
> �� Q � .�_�� - _ ���o
e o �-a. o . � � certity that on, e tsi day of March, 79
�) occupied as our principal place of residence the following described real pmperty for which a Homesiead Propert -Cre it�erehv claimed:
s�,
1(We) owned ❑ Are buying under contract . ._ , 3�%DITQR�^�
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns ihe property or is buying under a contraci.
� - CONTRACT RECORDED �
11 Wying on contract, Fee Simple owner's name - - - , - • - -
Recortler's oftice where mntract is recortled Record number Page
Counry
Parcel number
11 any ponion ot the residential strucNre or
of the pmperty utilized to produce income.
Counry
Address
PROPERTY DESCPIPTION
Townsttip
Legal description
town.
lantl not exceeding one (1) aae Ihat immediatety surmunds Ihat strucmre is used ro produce income, describe the use antl portion
�PROPERTV OWNED BY CIAIMANT IN OTHER COUNTIES
certify the above statements are tme, correci and complete.
code)
SgnaNre
��
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE �VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately
surrounding resideniial improvements. I (�)
Otherland (2)
Total land (line 7 plus line Z� , (3) I
Dwelling (4) �
Residential improvemenis
Garage (5) �
Otherimprovemenis (6) '
Total improvements (line a through lina � (7)
Total value (line 3 pbs line 7) (g)
I hereby certify ihe above is Irue. CorreCt, and Signature of Assessor Date signed
complete.
�tying action - Sgna;ure of Auditor Dare signetl
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