Homestead_Cox STATE FORM 53569(R3/8-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.22009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-8.1
o IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS ;`
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
eduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
s 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 I«^
_. .. .. -ate-:?Y4; +-:
Ta spav'er Name property Addref5 State Parcel Number Lent Pest:infirm:
Jerry W/Deanna I Cox I 6784 E 150 S 26-13-17-300-000.340-004 PT SE SW 17-2-9 4.50 AC
FRANCISCO IN 47649 C-I D-7
Complete and return to: 2Ii1111111 EREiltiMaiiiiiiiiii0iiiiiirlilli]IIIWI
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
Owner I First Middle Last
.-1)e null 3—At e� ci / L px,
MaAUq caress( and so-eel.city,state era ZIP curie) 1 a /Sarre as property address
Middle . Last
-3-en.v WA�.,✓e CP/C
mama ess(number and street,city,state and ZIP code)
Same as property address
Social Security Numnef(last 5 digits) Driver's License/State ID Number(last 5 digits) slate Other(please soerity in Part 4 below)
t. i .. _ 1 ,: 1- ../..„ .4 C. PART.3.-CERTIFICATION_ . 2..-'` r•-_ A.: .t
,.2
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 I Signature Date
;,
FIL -
•
NOV 5 2012
c. .m
GIRS(IN rill Ito, Aty:-.TOR
4
I Vtr:.l I,y IU �
ilesco0ty By $laze Btem of ia. CUploossioneis
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19
SEE BACK FOR FILING - INSTRUCTIONS ✓/ pOo %'003et0 -o0 /
certify that on the 1st day of
Iv i, 19 ja I, (VA) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We)A- owned
❑ are buying under contract
❑ have a beneficial in Brest in the taxpayer
Property Description in County Township
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name 11"
or legal description shown on tax statement:
lot" Ely' � i7 -� 9 Al 50
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
<'G -43 / 7- ,300 -trio• 3 o -oo
Any other counties in which individual owns or is buying real property: County Township
I Pby certify the above statement is true, correct and
complete.
Signature sueel Aa�ress
30
�% . na
Ciry�. Statc ark "p Gode
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 -
True Cash
Assessed Homestead
Value
Valuation Valuation
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other Land
Total Land
(1) a 0 'J
(2)
(3)
3 0
7 p D
1 30
Residential Improvements
Dwelling
(a)
/
Garage
Total
Other Improvements
Total �rovements - Line (6) plus (7) equals (8)
(5)
(6)
(7)
(8)
r—(OS O Aso
3 j
7
I heref,, certify the above is true. correct. and complete.
Sigmzuie of Assessor
f41r
ACTION BY AUDITOR -
j�
ADoroved: .� . ° it `tors
--
Date: