Homestead_Herrin STATE'OEM.!vn1Rl...I 1WE15nrlR FORM TS-IA
• APPROVED fri SPCIL BOVIo Or Myrt'NI S.N. PREYRInm BY nlr DEPARTMENTOF LOCAL rovB NMrIrr FINANCE IC 6-I.I-r-.1.1
Gibson County Auditor
11 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N
PRINCETON IN 47670 Individuals and married couples are limited m our homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than e'er for homestead fraud.Homestead fraud causes higher in bills for all:therefore.
HEA 1344-2009 requires taxpayers who recetive the homestead standard deduction to verify that they arc eligible to receive the
• benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This information will be kepi confidential and can only be accessed by authnrieed county officials.The Dqunnrnt 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
Herrin, Patricia J
5440 F 50 N
Francisco IN 47649
2125
Patricia J Herrin
5440E 50 N State Parcel Number Leal Description
FRANCISCO IN 47649-8912
26-12-01-400-000.683-004 002-00683-00 PT E SE 1210 1 AC
IIIttIIIIIIIIItllItllllltlltlltllltllllIllllllulllllllllllltll c-1 D-7
PART 2: TAXPAYERINFORMATIQN
Owner I • First Middle Last
•PATR/%A t o PI RRIA1
.g'Address(number and sutra.city.cs:ete.and 7 P code)— - - - -
5Lf-/o 50 RAAIt-/3cO, /A✓ X74 c47
Spouse First • Middle Last
Mailing Address(Number and street,city,stale.and ZIP code) ❑ Same as propcny address
— Social Security.Numbcr.(lac.5.digits)_, Driver's Licensc(State,ID Number (Iasi 5 digit_ Other(please specify in Pan 4 below)
sire
- PART 3:CERTIFICATION
Each undersicmed 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.
Oss'nerl IgnaWre Date '
110
•
CLAIM FOR HOMESTEAD PROPERTY TAX
s CREDIT /STANDARD DEDUCTION
State Form 5473 (13215-92)
+su
INSTRUCTIONS: See reverse side for filing instructions.
W-4 F 1
YEAR TTO
' CERTIFICATION STATEMENT JQR11 S
�) certify that on the 1st day of March, 1�
F-1 ''' '9
,.de) occupied as our principal plat rest a ce the fo wing described real property for which a esl k-P'P4 Rx wilt is hereby daimed:
❑ I (We) owned ❑ Are buying under contract BUJ jI 11
❑ Have 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 contras. Fee Simple owners name
Rewrder's office where contras is recorded Record number Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
PROPERTY DESCRIPTION
County
Township
Township
Taxing district (city, town, township)
Parcel number
00 _DWM -00
Legal description
- -/O
If any portion of the residential structure or the land not exceeding bne (1)
acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Sign cur f cl
Address (number and street city, state. ZIP code)
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (line I plus line 2)
(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
- plete.
p
Signature of Assessor
Date signed
action nature of Auditor
Date signed
19_Pay 19_
Lesser of 112 Homestead
Valuation or $2,000
Signature of Auditor
�d
STANDARD
S