Homestead_Henson STATE FORM 53569(R3/11-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.2-22-5.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
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, HEA 1344-2009 requires taxpayers who receive the homestead
e dard 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.
PARTI: PROPERTY IN OR,MA ION
Ta:narer Name Properts Address State Parcel Number Leoal Description:
Terry A/Robin L Henson 12620 S 40 W 26-23-18-300-000.428-024 PT SW 18 4 10 .55 AC
HAUBSTADT IN 47639
Complete and return to: 1111111[1111111111111111111111001111311100111M111111111
GIBSON COUNTY AUDITOR, 101 N MALN PRINCETON IN 47670
PART 2: TAXPAYER INFORMATION
Owner I First Middle NE.vsa�✓ Last
Mailing Address(nunter and street,city,state and ZIP code)
xSame as properly address
X2.6 2.(25 S, 40 1V, 4c,e a.cildri /A/ 9763y
Middle
eosin/ Z, /esae‘..)
Stating Address(natter and street.city,slate and ZIP code) / ` Same as property address
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.
Omer 1 Signature Date
PART.4: ADDITIONAL li\FORMAT10\ .
. FILE
• NOV 1 4:2012
GIBSON:COUNTY AUDITOR
d��,� i CLAIM FOR HOMESTEAD PROPERTY TAX � pORM YEAR
;���: CREDIT/STANDARD DEDUCTION HCio 9
.�;,;�� State Porm Sa73 (R2/5-92)
,bi.
INSTRUCTIONS: See reverse side lor Iiling instructions.
�Ne) / � e�' bS.v-`� _'_F/-�—� certify that on �i �y of �, 19�
�) occupied as our principal pla of residence the tollowing described real property for which a Homestead Property�Credit is hereby claimed:
❑ I(We) owned ❑ Are buying under contract �� �, �r�S
❑ Have a beneficial interest in the entity thai is liable for the property taxes on the property and thai owns ihe property or i i i�j.Q� contract.
� � CONTRACT RECORDED � .
If buying on conirad, Fee Simple owner's name � , .. , �
Recortler's oMice where contrect is recordetl Record number Page
PROPERTY DESCRIPTION
Counry . ' Township Taxing dis[r' t city, t n, low,
Parcel numDer � Legal tlescnption � / I
-iv-
If any portion of the residential simcture or the la� not exceeding one (7) acre that immetliatety surmuntls that strucNre
ot the pwpeny utilized to produce income.
Counry
PROPERTY OWNED BY
certify the above siatements are true. correct and complete.
Atltlress (numberandstree(. ary, state. ZlPmde)
SV / �
IN OTHER COUN'fIES
ed to produce income, describe Ihe use and portion
Township
.l� �, �
�N
ASSESSOR USE ONLY TAUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately .
surrounding resideniial improvements. (�)
Otherland (p�
Total land (line 7 p/us line � (3)
Dwelling (a) .
Residential improvements
Garage (5�
Other improvemenis (6)
Total improvements (line 4 through lina � (7) �
7otal value (line 3 p6s line � (g) .
I hereby Certify the above i5 Irue. CorreCi, and Signamre ot Assessor Date signed
complete.
ymg action - Si9namre of Auditor Da;e signed
�
19_Pay79_
Lesser of 1/2 Homestead
Valuation or 52.000
DEDUCTION ALLOWANCE
S
Dare