Homestead_Emilio STATE FORM 53569(53'B-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF COINTS.209 PRESCRIBED BY THE DEPARTMENT OF LOCAL GONTINMEN'T FINANCE IC 61.1-332.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and mauled couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
- Pflnceton, IN 47670 more beneficial,there is more incentive than ever for homestead fraud.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
II 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.
PART I: PROPERTY INFORMATION
FILED Taxpayer Name Location Address
Emilio, Bryan K/Judy B
q 12574 S OWENSVILLE RD
APR O p�B 2011 HAUBSTADT
I N 47639
96 . C.3. Ir Im/mill lino/11 1I1I IIIII Ill/m ID
I I
II Bryan K Emilio
1257 . weDITOR
Haubstadt IN 47639-8703
"'IIIllllllllii,lilltlilIllItlltllttllltIll'illll'lll'llllIll'
State Parcel Number / Legal Description
'
__ _
26-22-15-300-000.01802_4/ PT SW 15 4 11 2.SO AC D-2 —
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.•• -IR ,-1 . ..ION -- -- —
05 . l� First Middle Last
-y,>�,� iLEi7* yyy�t ) lea
Mailing Address(number and stmt,city,state,and ZIP code) I `Same as property address
b9-_5-7`� 5 ou-a's�,r 1/e An ,65T-",o; iti 47e, 3 ,
Spouse Fiirst Middle Last
– - �ufly---- — I IJE=TK--- 1 � M - — - -
Mailing Address(Number and street,city,state,and ZIP code) ®Same as property address
/C25i'f 5 0WegsVtu C RD /l4u.$STk,-r =A 47(.39
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 Sift/ - Date
�"`��""°- CLAIM FOR HOMESTEAD PROPERTY TAX FoRM YEAR
�� CREDIT/STANDARD DEDUCTION HCto
'- �a State Fortn 5473 (R2 / 5921
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�2!]9�
INSTRUCTIONS: See reverse side (or �ling inshuctions.
CERTIFICATION STATEMENT
'�e) � ceAify that on lliP1§t da�of 14T2T�, 79_
I(We) occupied as o principal place of residence the following described real property for which a Homestead Pr rty Tax Cred� is eby clai ed:
❑ I(We) owned ❑ Are buying under contract .
❑ Have a benefidal interest in the eniiry that is liable for the properry taues on the property and that owns the prope�fj����iiq r�'i��"�in�e�'a�rS�h2t.
CONTRACT RECORDED
If buying on conVact, Fee Simple ownels name
Recaraer s oHice where contract is recorded , (±ecord number Page
PROPERTY DESCRIPTION
Counry Township Ta:cing district (ciry, fown, tmmship)
Parcel number Legal description
- t - - a-SO t�C..
If any portion ot the residential structure or Ne land not exceetling one (1) acra that immedia[ely surtounds that swcWre is usetl to D���e income, describe Ne use antl porfion of
the property utAized ro produce income.
_ � - o�-ODO. /1�-d�
- PROPERTY OWNED BY CIAIMANT IN OTHER COUNTRIES
Couniy Township Counry Township
Si9 a re o( irttant
areby certify the above statements are true, correct and complete. �^��
A (nu r aiM street, clry, state, ZIP e) '
1
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding t(one) acre immediatety (��
surrounding residential improvements.
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential imprwements
Garage (5) �
Other improvements (6)
Total improvements (line 4 through line 6J (7)
Total value (line 3 plus line 7) (8)
I hereby ceRify ihe above is Irue, cortect, and Signamre of Assesor Date signed
complete. �
Verifying action - Signawre of Autlitor Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _ .
Lesser of 1/2 Homestead $
Valuatlon or 52,000
Siqnature of Auditor Date si nedL �\
—J �Ll