Homestead_Richardville STATE FORM 53569(R2/2-09) TREASURER FORM TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1.222-5.I
IMI t O ' £1! NO 1C .'U@) HOM 'S A D ' ROP ±' Y 0 WNi 416
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
s andard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
0
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.
ARTL: ROP YINFORMAt1101N .. -: .
Taxpayer Name Property Address State Parcel Number Legal Description:
Benjamin Lee Richardville 1063 W 1200 S 26-22-13-100-000.326-024 004-00326-00 PT NE NW&PT NW
Haubstadt IN 47639 /_/ NE 13 4 I 1 14.263 AC
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
�.. . , -,."44.4.. . . ..A - le,; ..-iv' U-&tf IM 1 TIO\..1`-:' o- rn;l !H -Sj-:. P:"Ye S.'-ilialtie. r ..
Owner 1 First Middle Last
,OEN o79inrn/ /%f t fi.rc/A-?,o vz 4 et-
Marc Address(number and street,city,state and ZIP code) I t Samp as properly address
as
Madre Address(number and street c y,state and ZIP node) 0 Same as property address
Social Security Number(last 5 digits) Drrrees License State ID Number(last 5 digits) sale Other(please specify bm Part 4 below)
,xtCFRTIF,ICJA�TI'01 ° + '' -'
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 Signalise Date
•
CLAIM FOR HOMESTEAD PROPERTY TAX
- " CREDIT/STANDARD DEDUCTION
♦ ,.» � srate Fam sa�a (rts i �o-0t)
Prescribed by ihe pepartmerrt d Local Govemment Finance
INSTRUCTIONS: See ieverse side /or �ling instrucfions.
FORM
HC10
YEAR
• ' ` Utl; 17 LUUZ
I(We) certiy that on the 1 st day of March, 20_
1(We) occupied as our p�ndpal place oi residence fhe f Imving des �bed real property for which a Homes d Property T C� it is hereby imed:
(We) owned ❑ Are buying under contrad �
Have a benefidal interest in the enti that is liable for ihe ro e taxes on the ra e and that owns the �RCn � �t�'' i'': �t i��7IT(�R
ty p p rry p p rty p73{se� o7R buy�ng uhder a contraG.
If buying on conirad, Fee Simple owners name
Recorders alfice where conUaq is recorded
Record number � Page
County Tamship Tain d'(riry, town, township)
Parcel number Lagal deuription Is Ne properry in question:
.. Droperty ❑ MoWle Nomo p.C. &f.f•� -
H any poAion o/ tne reaidentlal struc4ire w the land not ezceedinp one (1) aue Net immediatey wrtounds �hat sW re is used to praduce incane, desaibe ihe use and portlon
of the proparty utii¢ed tn produce irroome.
County
Twvnship
I hereby certify ihe above statements are We, corred and complete. I
"dress (num6er end s6oeL dry; atate, ZIP coda) ?y�
LYlt � 2 I}AN?S7?qOT iw �%7�Ty .
Coumy
SignaNre of Gaimant
�� �
�
. -�� '�5�`�'#�'�`STANDARU'6EDUCTION'9LCOViIANCE{r�'�sas.�y -. •: �_� `- � -`� ' . Q.s�=`�
`"�rz�'��Y�`=t� �'-` - �',.� _ _ _ �_sa'�6n� �3rkc.���`"���_
_�
20 _ Pay 20 _
Lesser of 1f2 Homestead
Valuation or $6,000 $
SignaWreafAudNa " Dates'gned
.�` "Q