Homestead_Lockyear STATE FORM 53569(R3l3-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.142-8.1
IMPORTANT NOTICE.TO.HOMESTEAD OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
inction 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 1: PROPERTY INFORiCIA ION
banner Name Properly Address State Parcel Number Legal Description:
Patricia A Lockyear 4943 E 1 UO S 26-23-12-300-002.034-024 PT NE SW 12 4 10 I AC
HAUBSTADT IN 47639
Complete and return to: I10IIoni I®OtwBmm�0.01BEEIMBH
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 11u
PART 2:TAXPAYER INFORMATION -
Owner 1 First Middle last
Mailing Address(number and street.city.state and ZIP cede)
Li Sarre as property
0Q 43 I ISc S / tub &)o -1 i W 71e39 address
Spouse First Middle • Last
Mailing Address(number and street.city,state and ZIP code) Same as property addresi
Soda)Seasity Hunter(bst 5 digits) Givers License/State ID Hunter(last 5 digits) Sae Other(please specify in Part a below)
•
•
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.
1 Signature Date
PART 4:ADDITIONAL INFORMATION
•
A
CLAIM FOR HOMESTEAD PROPERTY TAX FoRM YeAR
� CREDIT/STANDARD DEDUCTION HC10
� State Fwm Sa73 (R6 / 1-03) � � �j
q' P � � 1L 1LJ
Presaibed 1he De artment of Local Govemment Finance
INSTRUCTIONS: See reverse side !or liling ins(nictions.
. �
I(We) ce�f,j(�' ihat on Ihe '1 st day of March, 20'
I(We) occupied as our principal place oi residence the follo ' g descnbed real pmperty for which a Homestead�Prope ty,�a./c-Credit�is hereby daimed:
❑ 1(We) owned ❑ Are buying under wntract �� GIBSOW CGUU� v 1�I�'TOn �
` Have a benefidal interest in the entity that is liable for fhe pmperty taxes on the property and that owns the property or is buying under a conVaU.
If buying om m�irad, Fee Simple owners name
whera mntracl is recorde0
Rewrd number � Page
Counry - Tamship Tacing district (ciry, town, townshiP)
Pa 1 u r �(�� L np , Is t0e propeM �� question:
� ` � � G(J �, `/O ❑ Real proPerty ❑ Mobile Homo (I.C. 61.1-7)
N any porUon of Ne residential sWCWre or the land not exceeding one (7) aae that iryme�te�nounds that swcture is usee to Droduce income, describe the use and poNOn
ot the property ulilizetl tn produce income. /
vi.r.��ii Q��riie
20_Pay20_ I
Lesser of 1/2 HOmesiead 5
vaiueUOn a f35.000
Signamre or rweitor
�
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