HomeMy WebLinkAboutHomestead_Petitjean STATE:ORn 53507 R13-09) TREASURER FORM TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE la-1.1-22-13.I
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 1344-2099 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. • -
PARTt: PROPER Y INFORMAON . •
Tasnaver Name Property Addrress State Parcel Number Le=af Description:
Anthony E Petitjean O / /�� fit) 26-23-16-400-001.617-024 004-01617-00 PT SW SE 164 10 1.08
Haubstadt IN 47639 x AC
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2:TAXPAYER•INFORMATION •
Omer 1 First Middle ' Last
/ k/TMoV 1( lO —I �,p��
Address(nunter and steet city•state and ZIP code)
Same as property address
I
.
Spouse First Middle Last
Mailing Address(number and street,city,state and ZIP code) Same as property aEdiess
I
Social Security Number(last 5 digits) Drivels License State ID Nunter(last 5 digits) Sou Other(please specify in Part 4 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.
Owner 1 Signature Date
• ( )
PART 4:ADDITIONAL INFORMATION .
•
�
�yE?��(
e/ °g CLAIM FOR HOMESTEAD PROPERTY TAX�
�t
CREDIT/STANDARD DEDUCTION
d'
..�r .,;��� State Form 54731R2 / SA2) . ,
��Ti .
INSTRUCTIONS: See reverse side 7or 7iling instructions.
occupied as our prin�l place.of residence the following described real property
;_� ,.
.. � 3 ���'�'�1
�. �
i � �
�certify ihat on the 1st day of March. 19=�/
a Homestead Property Tau Credii is hereby Gaimed:
I(We) owned ❑ Are buying under contract �
�iave a beneficial interesi in the entity that is liable for ihe property taxes on the property and that owns the property or is buying under a contract.
CONTRACTRECORDED
It buying on contract. Fee Simple owner's name
PROPERTY
Counry
Tari� di5tritt (ciry, fown, town5hip)
Record number � Page
�O'� - O I (� i �1-00 � �%� S t,� S £ . l (p - �{-- l � . � � �g �J
It any ponion of ihe residential sirucWre or the land not exceeding one (7) acre that immediatety surrounds that structure is used to produce income, tlescribe the use and ponion
of the propeny utilized to produce income.
� PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES � '
Counry -_, Township _ Count - To�mrstsp----
reby certify the above statemenis are true, correct and complete. � wr of ciaim � G� �/ �� �
(i(.��%fC
-""1r ber a 1reeL ciry. state, Z7 code ,/7, 7�
Y i ���/
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land no� exceeding 7(one) acre immediately �
surrounding residential improvements. (�) �
Oiherland (p)
Total land (line i plus line Z) (3)
Dwelling (4) � - � '
Residential improvemenis .
Garage (g) '
Oiher improvements (6)
Total improvements (line a through line � (7)
Total value (line 3 pbs line 7) (g)
� hereby Ceflify the abOVe is Irue, COrreCt, and SignaWre of Assessor Date si9ne�
complete.
�tying action - Signamre ot Audimr Date signed