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STATE FORM 53569(0.3/840) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1-222-9.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS =17'
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
�
iuction 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.
PAR k PROPER Y INFORMA ION
Taxpayer Name Properly Address Stale Parcel Number Leval Description;
Kevin D Hogan 1860 S LAKEWOOD CIRCLE 26-13-20-200-000.547-004 LAKEWOOD HILLS LOT 5
FRANCISCO IN 47649 C-1-D-7
Complete and,return to: IGIHI:U1uIJt1pllieluu IMII] ihli1i1i[1 llHilllhIH tutu-
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2: TAXPAYER INFORMATION •
Owner 1 First Middle nn Last
�l l/i.V Do->J / P (�'�� 1� Oc�ae�
Mailvg Address(number and street.city,state and ZIP code) I as property address
I
� .
Spouse First Middle Last
Mailing Address(number and sweet,city,state and ZIP rode) Same as orooeny address
Social Secunty Number(last 5 digits) Drivers License/State ID Nwnber(last 5 digits) state Other(please shortly in Part 4 below)
, PART 3'CERLLF_IC 10 o-s " ' r
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
( )
••. PART 4: ADDITIONAL,INFORMATION r'.+
..
•
NOV $ 2012
v
GIBSON COUNTY AUDITOR
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (118 17-07)
Prescribed try the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (We) certify that o (h�.l sAdy jWjach, 20_
ied
I (We) occup as our principal place of res' the following described real property for which a Homestead ProperC JCredtt is hereby claimed:
tr� 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 the prope rt y o r6u'ng under a contract.
CONTRACT ••. r
If buying on contract, Fee Simple owner's name
Recordefs office where contract is recorded Record number Page
County I Township
number
Is the property
If any portion of the residential structure or the land not exceeding one (1) acre than' a surrounds that
at the property utifized to produce income.
a6- 13- (:201 CA co -rrn..s
at property ❑ Mobile Home (IC 6- 1.1 -7)
is used to produce Income. describe the use and portion
PROPERTY OWNED BY CLAIMANT I
IN OTHER COUNTIES
AS§ESSED.VALUE NON-RESIDENTIAL
USE ONLY TRUETAXVALUE AT 100% OF TTV
VALUE
Land not exceeding 1 (one) acre immediately'
surrounding residential improvements. (1)
Other land (2)
Total land (line 1 plus line 2) (3)
Residential improvements or Annually Dwelling (4)
Assessed Mobile / Manufactured Home
Garage
Other improvements (6)
Total improvements (line 4 through fine 6) (7)
Total value (line 3 plus fine 7) (8)
1 hereby certify the above is true, correct, and Signature of Assessor Date signed (month, day, year)
complete.
Verifying action - Signature of Auditor Date signed (month, day, year)
111-1.4 Ij 11 =ql • •
< _ pay 20 _ 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 1/2 44,000 for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead Valuation $
or 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor Date signed (month, day. year)
111-1.4 Ij 11 =ql • •
< _ pay 20 _ 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 1/2 44,000 for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead Valuation $
or 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor Date signed (month, day. year)