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Homestead_Kolb SLATE LORM')!t4 IC,!-wl IREASUP,EB FORM CIA APPROVED BYATAtL!MAD OF«mous,(Y.n Prl_YRIar➢BY illr DEPARMEYT OF LOCAL C4RERYMra,r B.'A\CEM1.I.1-224.1 Gibson Count9 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 eser for homestead fraud.I lomestead fraud causes higher tax bills for all:therefore. • HEA 1347-2009 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 goremmenl to better monitor homestead flints. this information will he kepi confidential and ran only be accessed by authorized county officials.The Ikpanntenl of Local Government Finance will use this information to create Rids that will help county officials eliminate homestead fraud. PART 1: PROPERTY INFORMATION Taxpayer Name Property Address Kolb, David R/Maria J RI Box 2b4 E _ _. — —_ _ __ , _ — _ __ .Fmncisco-IN 47649._ 4635 David R/Maria J Kolb 1827 Lakewood Circle State Parcel Number Legal Description FRANCISCO IN 47649 26-13-20-200-000.175-004 LAKEWOOD HILLS LOT 16/18 XC-1-D-7 • • PART 2:TAXPAYER INFORMATION Owner I First Middle Last wv,d g . Al /6 ng Address(number and street,city,state,and ZIP code) - - _ — — Same as prapeW address — — — - - - .-- / X27 Cwkewooc C;rcie Frctvt c o J%✓ cf76619 Spouse First 1 Middle Last M0.r . GA. J . /1 U Mailing Address(Number and street,dy,state.and ZIP code) © Same as property address 7 27 t"1C t, 1/Velike C%rcie cccCc 1// Y76V 9 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 • CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR CREDIT /STANDARD DEDUCTION HC10 State Form 5473 (R2/5-92) Hsu INSTRUCTIONS: See reverse side for filing instructions. 7M r W. ''e) —L ��3k RAID— n&KXE_ certifyNA)on.tnaft jWof March, 19 / 7= ` upied as our principal place of residence the following described real property for which _a Home d Property tTax yCredit is hereby claimed: owned ❑ Are buying under contract1tI'1II fn1p�'�, e� El Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prAMyrOr Q g under a contract. CONTRACT RECORDED - - It buying on contract, Fee Simple owner's name Recorder's office where contract is recorded Record number Page 11 PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES ' PROPERTY DESCRIPTION County Township - Signature of claimant Taxing district (ci , to , towns r) , P rcel n mber Legal description c' 00,1-00)75-00 (2) lx] It any ponion of the residential structure or the tend not exceeding one (1) acre that immediately surrounds that stakrure is used to produce income, describe the use and portion of the property utilized to produce income. Total land (line I plus line 2) (3) 11 PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES County Township County Township W-reby certify the above statements are true, correct and complete. Signature of claimant Address (number and street, city. state. ZIP code) f l a44(E fo4 - 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) Date si /�' n 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 p!/s line 7) (6) 1 hereby certify the above is true, correct, and complete. Signature of Assessor Date signed lying action - Signature of Auditor Date signed STANDARD DEDUCTION ALLOWANCE ' 19_Pay 19_ Lesser of 1/2 Homestead $ Valuation or $2.000 Signature of Auditor Date si /�' n