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Homestead_Ellis aIA1E FORM'IYwIR-/DAM nrssuna DORM TS-IA APPRO.. NOTICE TO t*PAATNITSAt OF LOCAL PROPERTY uOWNERS Gibson County Auditor '101 N Main PRINCETON IN 47670 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 eser 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 filing. Mix information will he kept confidential and can only he accessed by authorized county officials.The Ikpanment of Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud. PART 1: PROPERTY INFORMATION Taxpayer Name Property Address Ellis, Patsie RI Box?73C Francisco IN 47649 4792 Patsie Ellis 2696 S 750 E State Parcel Number Legal Description Francisco IN 47649-9053 �t�hh��ttr�t��rtt�tt��t�t t�r�t h��mttm�t�mtt��t�t�tt t��t t�t t�r� 26-13-28-100-701.389-004 002-01389-00 BLDG ON LSD GRD PART 2: TAXPAYER INFORMATION Owner I First Middle Last _ Pfsie ANA/ kL1. �s •ig Address(number and strt,city,state,and ZIP code) - O Same as property property addr s; —--- - - ' " - street. G 91 S ?CO L 7PA Nc,sc o /7 co 99 Spouse First Middle Last � D Al2, Mailing Address(Number and street city,state,and ZIP code) ❑ Same as property address Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 Mow) - - _ _ _ State • --7% ._-t"----`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 I Signature Date PART 4:ADDITIONAL INFORMATION • CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR CREDIT /STANDARD DEDUCTION HC10 (7/5 State Form 5473 (R2 15-92 eia INSTRUCTIONS: See reverse side for filing instructions. CERTIFICATION STATEMENT - - I (We) UA6..t - certify that on the 1st day of March, 19 J I (We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed: l(We)owned ❑ Are buying under contract 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 owner's name Recorder's office where contract is recorded Record number Page PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES PROPERTY DESCRIPTION County Township Township Taxing district (city, town, township) Par I number a- 01384' - ©0 Legal description - If any portion of the residential structure or the land not exceeding o (1) acre that m ediatey surrounds that structure is used to produce income, describe the use and portion of the property utilized to produce income. , tt- PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES County Township County Township I hereby certify the above statements are true, correct and complete. Signature of claimant �ess (number and street, city, state, ZIPcode) - ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL VALUE Land not exceeding 1 (one) acre immediately surrounding residential improvements. (1) ' Otherland (2) Total land (line I plus line Z) (3) Residential improvements Dwelling (4) _ Garage (5) _ Other improvements (6) Total improvements (line 4 through line 6) (7) Total value (line 3 plus line 7) (g) 1 hereby certify the above is true, correct. and complete. Signature of Assessor Date signed - Venfying action - Signature of Auditor Date signed