Homestead_Ralph (3) •
'• cleat FORM att.IR'/YMI TREASURER FORM TS-IA
APrRm'ED BY MATE RlwRD OFMnrS_2 S PRLw-Bm BY TE DEPARflO.\r OF LOCAL CA ztNMrsr FINANCE KH.1-l'4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
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 ever for homestead fraud Homestead fraud causes higher tax bills for all:therefore.
® HEA 1344--3009 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 he Leo conlidential 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.
PART 1: PROPERTY LNFORMATION
Taxpayer Name Property Address
Ralph, Todd C/Connie J U qh,1 $. Rosclfc. j).,,
K2l3oxl 1 -
11 stash IN 4763
3517 V
Todd C/Connie J Ralph
12474 S ROSETTA DR State Parcel Number Legal Description
Haubstadt IN 47639-7939
ltlullutlullnnlltltlnlntlltlnnlltltlnit.'lrl u1.1111l 26-23-17-200-001.672-024 OD094-01672-OO BENKERT EST 2
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
TODD C . RkLfll
Ong Address(number and strees,city,state,and ZIP code) Same as property address
a +1 L{- .�. 1oSETf DR , Au[isnmT S7J 4:1 39
Spouse First Middle Last
CO!INIE Jo RA1--fl-f
Mailing Address(Number and street,city,state.and ZIP code) Ill Same as property address
a 14-1 LI- S. 1bS�-rr# -, A asyktyr-
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 gnat Date
•
•
•
�,,...,�
ea '°, CLAIM FOR HOMESTEAD PROPERTY TAX
l; �= CREDIT/STANDARD DEDUCTION
�i,
Staie Form 5473 (R2 / 5-92)
m
INSTRUCTIONS: See reverse side !or !iling instructions.
. .. � _ . .. . . .. �..-....��
• FORM YEAR
HC10
e� 0 V� � � ��--� �certify.ihai on the 7si day of March, 19_
�) o upied as our principal place of residence the following describe real property for which a Homestead Property Tau Credit is hereby daimed:
/
((We) owned ❑ Are buying under coniract . . . � �� � �� �
Have a beneficial interest in the entiry ihai is liable for the property tares on ihe property and thai owns ihe property �s yi c tr t.
8
RECORDED
II buying on coniract, Fee Simple owner's name '. � - � �
. � �.
Recorder'S oflice where crontract is retorded Retord nu QR Page
. . . .. °''. � PROPERTY DES . ' . ..
Counry ' '� Township T' diStriCt (af to I• s .
� ber �� _ O O. Legal description
If any portion of the sidential stmaure or ihe land not exceeding one (7) aae ihat immediatey surrounds that strucwre is used to produce income, desaibe the use and portion
of fhe property utiGZed to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
certify the above statements are true, correct and complete.
num6erarMsrreeCUrystare.ZlPmde) , �
. ASSESSOR USE ONLY �
Land noi exceeding t(one) acre immediately
surrounding residential improvemenis.
Otherland
Total land (line 1 plus line Z�
Dwelling
Residential improvements
Garage
Other improvemenis
Totai improvements (line 4 through line �
Total value (line 3 p�s line 7�
I hereby certify ihe above is irue, correct, and
complete.
���•�fyirg aclion - Sgna:ure o� Autlitor
s
TRUE TAl(
VALUE
(�)
12)
(3)
(4)
(5)
(6)
I�I
(8)
Signature ofASSessor
of claimant
ASSESSED I HOMESTEAD I NON-RESIDENTIAL
VALUE� VALUE VALUE �
Date
signed