Homestead_Hurst STATE FORM 53569(R318-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERRNMSNT FE ANCE IC6-1.1-22-5.1
• t 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
uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
s adard 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 ti PROPERTY I'FORNIATIO\
Taxpayer Name .-- Property Address State Parcel Number Legal Description:
Bryan Hurst 1200 S 26-23-07-400-000.040-024 PT W SE 7 4 10 I AC
HAUBSTADT IN 47639 o-9
Complete and return to: . . "_II®II�OV®llllllm®UI®D1DiOi I&(p[II�®DIluIIV
. .... GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
u7IIdIW IWIn II
•
PART 2:TAXPAYER INFORMATION - .
Owner I - First Middle Last
Spa ��►�-� -
Mailing Address 'umber and street.city,state and ZIP code)
i''1 to r 14
��promrU
c 12..00 S au"o4a A l < -1 address.
!fie First Middle Last
herding Address(nurrcier and street.city.state and ZIP code) _ - Same as property address
Social Secodty Number last 5 digits) Drivers License/State ID blunter(last 5 dlgita) State Other(please specify in Part 4 below)
PA RT..3:'CERTI FICATION
- 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
d-PART 4: ADDITIONA!;I '. OR
�:iA:ION
•, r t
i
• nEC 27 2012
GIBSON COUNTY AUDITOR -
•
•
e%�"� a CLAIM FOR HOMESTEAD PROPERTY TAX veaR
i:a�� CREDIT/STANDARD DEDUCTION . ��� �i�i (��S
.�.,;� Stare Form Sa73 (R2 / 5-92)
"'° MAY 0 31995
INSTRUCTIONS: See reverse side Ior filing instructions.
� � - CERTIFICATIONSTATEMENT j.%! � � ;�; ,,• ";--
I(We) ���A �✓ f?Z(,25 i '�ceftiTy 1haYo�n the 1 st day of March. 19 Y�
�) occupied as our principal place of residence the following described real property for which a Homestead Property Tau Credit is hereby daimed:
I(We) owned .❑ Are buying under coniract
❑ Have a beneficial inierest in the entiry ihat is liable for ihe property taxes on ihe property and thai owns the property or is buying under a wniract.
CONTRACTRECORDED. - .
II Wyirg on contracC Fee Simple owner's name . . .
Recortler's oflice where contract is recordetl Record number Paqe
` PROPEflTY DESCRIPTION -
Counry . TownshiP _ Taring di5tnti (city, town, town5hip) , � .
G/i3so„� J oN.�so,�
Parcel number Leqal tlescripti /' I
DO �— 000 j�0—OD �'r G{/ s� 7 S�� l U � AC
If any portion of the residential simcwre or ihe la� not exceeding one (t) aue that immetliatety surrounds that swcture is used ro produce income, describe Ne use antl portion
of �he property utilized lo produce income.
- iivi-iiiri_ii ii�-
ASSESSORUSEONLY . � TRUETAI( -ASSESSED HOMESTEAD NON•RESIDENTIAL
� VALUE VALUE VALUE - VALUE
Land not exceeding 1(one) acre immediately I
surrounding residential improvemenis. (�) �
Otherland (p) �
Total land (line 7 plus line Z� (3) I
Dwelling (4)
Residential improvemenis _
Garage (5) `.
Other improvements (6)
Total impmvemems (line 4 through line � (7)
Total value Qine 3 p6s line 7� (g)
I hereby certify [he above is Irue, corrett, and Si9nature of Asseswr Date signed
complete.
Veritying aaion - SignaWre ot Auditor Date signetl
�
STANDARD DEDUGI ION ALLV WANI:t -
19_Pay19_
Lesser of 1l2 Homestead
Valuation or 52.000 S
Dare signetl