Homestead_Cross STATE FORM 53569(RI/9-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 ' PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-8.1
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
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.
. PARTI: PROPERTY INFORMATION w_ r a:y
Taxpayer Name Property Addresq State Parcel Number Leeal Description:
Michael W/Terri D Cross 807 N 550 E 26-I2-01-400-000.419-004 PTE SE 1-2-10 1.00 AC
FRANCISCO IN 47649 C-I D-7
Complete and return to: IHB'IUUhIalu,lulfE�lDhIO MIIQJIUUUD]BIDIrLll�p
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 W u7
_ ' PART 2:TAXPAYER INFORMATION ,
Owner I First Middle Last
Pei C.h / 1,04//GC e cosi-
Mayrg Address(number and street,city,state and ZIP code) I I Same as
property address
ts tee L,),(1 C teas'S
Mailing Address(number and street,city,state and ZIP code) Same as property address
• PART 3: CERTIFICATION •
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
FILED
AUG 9 2012
M " V
GIBSON GOON I r MUUI I Vet
CLAIM FOR HOMESTEAD PROPERTY TAX
�CREDIT /STANDARD DEDUCTION
• State Form 5473 (R215-92)
INSTRUCTIONS., See reverse side for filing instructions.
FORM r
MAY C 6 1999
YEAR
• CERTIFICATION STATEMENT -
Ir
�
1 (We ) "`"`c`ertifylli '� y of March, 19_
': n 1
�riv IUNTY .t
I (We) occupied as ur principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby 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 the property or is buying under a contract.
CONTRACT RECORDED
It buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township)
Parcel number
Legal tlescripiion
T /
_
1 any portion of the residential structure or the land not exceeding o (1) acre that immediately sun nds that structure is used to produce income, describe the use and portion of
the property utilized to produce income.
a
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township County
Township
®
Signatur of claimant
I hereby certify the above statements are true, correct and complete. C'
Address (number and street, city, state, ZIP code)
/
2 / l I q —d C
ASSESSOR USE ONLY
TRUE X
ASSESSED
HOMESTEAD
NON-RESIDENTIAL
VAL E
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
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 Assesor
Date signed
complete.
dtying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
$
Valuation or $2,000
Signature of Auditor
Date signed ._ n
JI