HomeMy WebLinkAboutHomestead_Davis STATE FORM$3569(RES-09) TREASURER FORM TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22 4.1
l \'I ' 10 ' AN 1tNO I 01 - 110H2OI M ;SS -A D ' °4 ' 0° Y OWN
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, FIFA 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.
i AR I k a 0 ' ' OSY mmethigY!II J •
Taxpayer Name 1 Property Address N State Parcel Number Leal Description:•
Gregory A/Michelle A Day id R 2 26-23-16-100-001.956-024 / 004-01956-00 COUNTRY AYRE
Haubstadt IN 47639 [� EST 62 13 D-9
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
j &Q ;3INFORMA1j[foljy,
Owner t First Middle last
Ma[ag Address(reinter and street,city,state are ZIP code)
I Same as property address
ia1� 3 3Qo (e1v�
LI)� CL .
MaSag Address(number and street,city,state and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivers (last 5 ddyigirtss)) sae Other(please speedy in Part 4 below)•• .. Ir&M P8 V.NYJ.A effaSr!NtallN 6.: `.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 xes and substantial financial penalties.
Owner I Signor a Data / ! O _
• . PART 83ki INFORMATION
1 �. _/ E P
. - JUL 1 9 2010
GIBSON COUNTY AUDITOR
•
` E ST1�F O
ia
.
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Siate Form 5473 (R2 / S92)
r FORM
HC10
YEAR
� INSTRUCTIONS: See reverse side for filing instructions. .
�� CERTIFICATION STATEMENT �
I (We) . �i� . a_�:[Sl . . �y �p —1 � 1 . � - 11 � certify that �MR 7 �Y r��ch. 19_ '
I(We) occupied as our principai place of � iden the following escribed real property for which a Homestead P rty Tax Credit is reby claimed:
�(V✓e) awned ❑ Are buying under contract
Have a beneficial interest in the entiry that is liable for the property tazes on the property and that owns the• o�q��{s b` a�r e��� R
CONTRACTRECORDED
If buyinq on contrad, Fee Simple owners name
Recordefs oHice where contract is recorded ' Record number Page
PROPERTY DESCRIPTION -
Counry � � Township ' Taxing istrict (ciry, town, township)
Parcel number Legal description
p <l - �� ��0�
If any ponion of Ne residenlial sirucNre or �he IaM not e:ceedirg one (7) acre Nat immetliatety sunounds ihat sWCture is used to produce income, descnbe ihe use and porUOn of
�he property uGlized to produce income.
�G- 3- - - /. �-a �
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry � Township Counry Township
Signature laimani
ereby ceAiry the above statements are true, correct and complete. C n
'C
Atldress (num6er and street, dry, state. ZIP podeJ
o � �T
ASSESSOR USE ONLY TRUE TAX . ASSESSED HOMESTEAD NON-RESIDENTIAL
VAIUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediatety (»
surrounding residential improvements.
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5) �
Other improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, correct, and Signamre o( Assesor Date signed
complete.
Verifying acuon - SignaNre of Autlitor Date signed
�� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead 5
Valuation or $2,000
Signamre of Autlitor Date signetl
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