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Homestead_Fortune STATE FORM 53369(10/&iO) TtEASL'FFY FORM TS-IA ' APPROVED BY SUM BOARD OF ACCOUNTS.NA PRESCRIBED BYTHE OEPARMEI OF LOCAL CAttAYMEYF FINANCE IC 4r1-112.1 Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS 101 N. Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes Princeton,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 - 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 D lu al Government Finance will use this information to create tools that will help county officials eliminate homestead fraud F I I E PART 1: PROPERTY INFORMATION Taxpayer Name Location Address APR 0 6 2011 Fortune David M/Victoria Sue r�—�- 11604 S 350 E C' '" -—f[-1• HAUBSTADT IN 47639 11390 v w\ DavidM"Vi°onaSueFort°toe - II.1-1111111IIIII.11111I111111I11IIII_III 1 MIL111111111�ifIIbi01101111111111111� 11604 S 350 E Haubstadt IN 47639-7901 III'IIIIIII'I'IIIIII'IIIIIII'I'III'I'IIIIIIIII"I1IIII11I1111"I State Parcel Number Legal Description 26-23-11-300-000.322-024/ W SW 11 4 10 20.00 AC 0-9 • . 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. ___-_-----__PARI'.a:_rt►sP111EIUNEO1tNt#tlo_N.-__----.-------------� _�_.�—_.------- Ow. ^��\\� � (��j - _ First y��y� -L Middle Last•1\. \,(_U.l V- 1 -t. V^ I.Q.` F131- 3\ tv R Mailing Address(number and street,city,state,and ZIP code) - E f Same as property address \l lot\ s 3 ;o &-1 \\a.‘00 SA-F(7\ t `--(—wt 4-lm ""`I Spouse - First - C Middle C Last She_ \ (iry\ 6..., 52 Mailing Address(Number and street,city,state,and ZIP code) EtSamte as property address \\ loOk-k. 3SO E._`, t-\r_�bstA_(SLC. S� ylla3 °\ - --- - . , 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/II tat titre - Date ww� Hc ia ie�s Rescri�M By State BaarE of Tae Commissioners , Ta & FileE in Dupli[aie -. . CLAIM FOR HOMESTEAD PROPERTY TAX CflEUIT FOR YEAR 19 8�- SEE BACK FOR FILING INSTRUCTIONS I(We)�� --� -�Y1 �- �'� A• -� •�I L— certify that on the 1st day of �rch, 19 b�Y I, (We) 6ccupied as our principal place of residence the following described real property for �ch a Homestead Property Tax Credit is hereby being daimed: ��aa,�� G-�3 //-v3�� t I, (We) ❑ owned QD �✓ Qo3� 2-V � ❑ are buying under contract ❑ have a beneficial intere�s/t in the taxpayer Property Description in /d-�-�°-^^� Cou Taxing District (City, Town, Township): � Parcel Number / legal desc ir ption shown on tax statement: Lt-% � z o5 GJ ��F / / - `F -. / o / 4� . �. . . �_�. / If buying O(1 contract: Owners name �'� simple owneq 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: I hereby certify the above statement is true, correct and complete. � �� Aoa.� •County 0 Township iery, auie ano uo �e Individual either owns or is buying under a contract that provides he is to pay the property taxes on the residence, or has a beneficial interest in the taxpayer. - FOR ASSESSOR'S USE ONLY - Land not exceeding 1(one) acre immediately surrounding residential improvements Other Land Total Land Residential Improvements Dwelling Garage Total Other Improvements Total Improvements - Line (6) plus p) equals (8) I tiy�by certify the above is true. correct. and complete. ol Ass¢SSOr True Cash Value (> > So 0 (2) — (3) .SOO �a� 3 3 3 Bo (5) � �s� 33380 (�) — �8� 3 3 3 So - ACTION BY AUDITOR - Assessed Valuation /70 i �jj��j��j/ jjj��j � ' f-�-r 3� /s�400 oate Approved: Date: Homestead Valuation i7o