Homestead_Blaize STATE FORM 53569(RSA-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE ICS-I.1 22-S.1
Y IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS x:
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
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 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 PARTI PROPERTY INFORMATION ;"f 4 '
Tasnasver Name Property Address State Parcel Number . La-al Description: //
Patricia G Blaze 4131 E SO N 26-12-11-200-000.100-004 PT NE 11-2-10 6 AC / -1
PRINCETON IN 47670 D-7 VVV
Complete and return to: 111191101GIOhII]R llfO Effi Iiffill 1111 r11KMIUV
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
t;'':- PART 2:TAXPAYER INFORMATIO■ � :,yMcC4
fl .;
aiLs
Maiing Address(number and street.city,state and ZIP code) r'- I Same as property address
I f qs S , ()Oen f; I J>? t C c L 14aubc odY rh , '/763 9
Last
` ` �li IL -� *t . 11
Mailing Address(number and sheet.city,state and ZIP ode) 1 Same as property address
111-134 _ itOen V ' / E A uista�� ...7-71 763 r
Social Security Number(last 5 digits) Drivers License/State ID Number(last 5 digits) sate Other(please specify in Pan 4 Below)
6IL. - _
a°a R4'3 fERTIrICA. '-2. l Y;. s• af.-- 1—.I7 --
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 Signature Date
e DEC 31 2012
MINIMMIlligitilli
P_ con
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 IRS 110-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
YA
YEAR �
I (We) tz..C_a cr
thlon the lsidatrAql arch, 20
I (We) occupied as our principal place of residence the fcAwing described real property for which a Homestead Proj6p(Tax &AVisMnaby claimed
❑ I (We) owned ❑ Are buying under contract
&Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns thep-rbperty I 1141J004iK, ct.
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded
Record number jPage
f
PROPERTY. DESCRIPTION v
County
Tmns
Taxing district (city, town, township)
1
L?
Township
0OZ -coo 160-400
Parcel n ber
Legal description
Is the property in question:
jl;Ldri�ss (number street,
LReal property ❑ Mobile Homo (f.C.6-1.1-7)
If any portion of the residential struct4r/ 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 in e.
— 73 elo 5/
Rif- OFiOftkT;(,&WNE6BYCL4IM4NT-1N-OTkEk'Cd"TIE!�,-��,,I�'�' `,si
t,�-,TRUETAX�-ftttli
ASSESSED VALUE
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Sign of claimant
:,_-� VALUE
Land not exceeding 1 (one) acre immediately
jl;Ldri�ss (number street,
Imly—Amis � ?�_
ems_ 4-'?, A -? o
—Date siqned
W USE ONLY
t,�-,TRUETAX�-ftttli
ASSESSED VALUE
A0A ESIDENTIAL
4&"j-
Nw
VALUE
W::_ _ �? M
9!�TTW
_,. VALUE'
:,_-� VALUE
Land not exceeding 1 (one) acre immediately
Value in or 56
Signature of Auditor
surrounding residential improvements.
—Date siqned
It
Other land
(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)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
--,Uo m
�5t�STANDARISMEDUCTION ALLOWANCE
20 Pay 20
Lesser of 1/2 Homestead
Value in or 56
Signature of Auditor
—Date siqned
0