Homestead_Witkop STATE FORM 53569(83/5-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-8.1
- IMPORTANT NOTICE TO H-OMESTEADYROEER-TYOWNERS=----------- ---
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
"auction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
uses 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.
PART1: PROPERTY I'FORNIA ION -
. Taunter Name Property Address: State Parcel Number ' Lepel Description:
1 I —
Tina•Df-Witkop - - - -- 3017 E 1025 S t.- ' - -- _ • -26-19-34-400-0.
6-19-34-100-000-397-024---- PT SE 34 310- .64-AC Z-
.- HAUBSTADT IN-47639i-- - D-10
•
Complete and return to: IIIMMMDD1IiQO G MMOBIIQO I U®EmO®
GIBSON COUNTY AUDITOR, 101 N MAIN-PRINCETON IN 47670 -
-
- .a - '- PART 2: TAXPAI'ERINFORMATION-
Owner I First Middle Last
Mailing Address(number and street city,sate and ZIP code)
Same as property address
Maitug Address(number and street,city,state and ZIP code) • - Same as property address
Social Severity Number(last 5 digits) Driver's License/Sate ID Number(last 5 digits) Mae 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 b liable for back taxes and'substantial financial penalties. - - -- - •
Owner 1 Si lure Date
- - -:PART 4:ADDITIONALINFORMATION :'
• . .
(4
.,, °",
`a e CLAIM FOR HOMESTEAD PROPERTY TAX
a:� CREDIT/STANDARD DEDUCTION
S�, Siate Form 5473 (R2 / 5-92)
/
INSTRUCTIONS: See reverse side for liling instructions.
.- - _ —K r.Fanc�r_er
FORM
HC10
YEAR
e) ( n`� `�' �. +. �_.�Q�i ceniry that on the tst ed�aX9�March, i9
`. —
e) occupied as our principal place of si nce the tollowing described real property for which a Homestead Pr��ty Y� �r 1� ereby claimed:
I(We) owned ❑ Are buying under coniract / ,�% / (�
o ' !/ .
Have a beneticial inierest in the eniity that is liable tor the property taxes on the property and that owns i pmperty or�is buying.uudeRa�contraa.
� .. . _ . � ;_ CONTRACLRECORDED.::- � - .:.r .� �:=y,,,. �- =�.k..4.
11 buying on contract. Fee Simple owner's name
Recorder's oflice where coniract is recorded Record numDer Page
PROPERTY DESCRIPTION- '
■
�
Counry 7ownship Ta � q di mct (crty, rown, rownsNp)
Parcel number Legal descnption
d -aa �-
If any portion of ihe residential stmaure or the land no[ exceetling one (1 � ave that immedia[ety surtounds that swaure is used to produce income, descnbe [he use and portion
ot Ne property utilized to produce income.
ASSESSOR USE ONIY � TRUETAX� ASSESSED NOMESTEAD NON-RESIDENTIAG
. VALUE VALUE VALUE VALUE--
Land not exceeding 7(one) acre immediately - �
surrounding resideniial impmvemenis. (�) - � m
Oiherland (Z) .J�E�o .:.� �-
Total land (line 7 plus line 2� �3)
Dwelling (a) � � ,' � .. . .
Resideniial improvements �
Garage (g) ,
Other improvements (6) � �
Total improvements Qine a through line � (7)
Total value (line 3 p6s line n (g)
1 hereby certify the above is Ime, correci, and Sgnamre of Assessor Da:e signed
complete.
trng action - Sgnamre of Autlimr Dare signetl
�•.
79_Pay19_
Lesser of 1/2 Homesiead
valuation or $2,000
$
Sg��ol Autlitor �/ , � �(� _ ^ I Date si9ned r, -
C \ CT (\ I 1 ` :� �_.. .
—��__ —C��'—L_J_ l—J�A O i �tr��C .,_ . - ' -a_'it� .:"_ .