Homestead_Willis STATE FORM 53569(R3R-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1-22-8.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS • I, .
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
•euses 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 Loc
Government Finance will use this information to create tools that will help county officials eliminat
homestead fraud.
PARTI PROPERTY-INFORMATION r 4 1 C:
Tatnaser Name Property Address State Parcel Number Leal Description:
Alva B/Ella Marie Willis 103 E POPLAR Si 26-18-24-204-000.879-026 MCCRARY ETAL 108PT/I09PT
FORT BRANCH IN 47648
Complete and return to: InIVllull0ullu11ll➢u1uIDlu711111n I1 Eommlu1u]ua11uu
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 -- --
_ PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
nLV4 Li, Le, s.
Mailing Address(number and street city,state and ZIP code) I 1,4Same as property address
/0 3 g o/,�L-&� S-{' F�1.-/' 3AA,J,1, HIT G f 8
-
S First l: Middle Last
Mailing Address(number and street,city,state and ZIP code) I 4 Same as property address
/ ° 3 E. �� 5f : Foie- , 47t 98
�k° M t PART 3,CERT,IFICATION
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that ne or she is eiigioie 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 SiSiiggd�atwe Date
.. _
R
*�� DEC 3-1 /UR
QIRSON COUNTY AUDITOR
WPM HC 70 195 io Be FileO in Duplicate
Presui�e0 By Staie Bw�O ol ia. Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT FOR YEAR 19� ✓
SEE BACK FOR FILING INSTRUCTIONS O��' OOb'Iq'O9
,� (We) �/I � . �"�"-�-� '°' • � �� � certify that on the 1st day oi
�sarch, 19� I, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned •
❑ are buying under contract
O have a beneficial interest in the taxpayer "�/
Property Description in �-�-�->-� �/ County ��-�+-a Township
Taxing District (C-rty-Town, Townskip): �'"� • �--�-'-L
Parcel Number or legal description shown on tax statement:
. �R.LsC_ �.-�r..,, / O 8' N �%
If buying on contract: Owners name �'� �'"'o'e °""ef� �` � / O %
Contract recorded in Recorders Office - Record No. Page
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 complete.
� !Ai',�/Yi. �iu:f�a `�" ��- �i�.z. (,c.%�-P�.� � /0 3
Sueet naaress
County
Township
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e.," — �..e�-s-roc.�
Gry. Sta�e ana Zip Coee �� ��
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Individual either owns or is buying under a contract thai provides he is to pay the property taxes
on the residence, or has a beneticial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding residential�r��s� �
Other Land
Total Land
Residential Improvemenls ��r� 2< i979
Dwelling
� �/�/��Z�Garage
AUDITOR Tolal
Other Improvements ��
True Cash
Value
c, � ��o
Assessed
Valuation
/ o
.
-� jj�j/��j�j
— ��i �%
(6j ��(°0
(�) —
Tr' Improvements - Line (6) plus (7) equals (8) (8) �"`���
I•�by certify the above is true. correct. and complete.
�:�
Homestead
Valuation
3s° %�
S�3 0 �� y
oaie
Date:----�sZ7C '/�