HomeMy WebLinkAboutHomestead_Siekman STATE FORM 53569(R2T-09) TREASURER FORM TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1"-8.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
,da4tuction 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
• 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.
PAR 1: PROPERTY_ :`FORMA ION ..:: - ,
Taxpayer Name Property Address State Parcel Number Lent Description:
e -er 31 `1 5 E 50 5.
Cheryl Knight Hoffer 41 26-12-14-100-000.261-004 / 002-00261-00 PT NE NW 14-2-10 37
Princeton IN 47670 [[[/// AC
C-I D-7
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
1\M-C.EN) p -\0- io
PART 2: TAXPAYER INFORMATION
0vmer I �� First r` h40dle `c Last
Mailing Address(number and street,pry,slate and ZIP code) N` -
Same asp uxity address
I9 q s . 17-00 E-
.
Space Fuss Middle j�� Last
n
Mailing Address(number and street.city,state and ZIP code)
� �� Sane as p,4.rryaddress
'
Each undersigned certifies,under penally of perjury,that the above and foregoing information is true and correct and that he or she is eligible to receive the
homestead standa i• •eduction on this property.Each undersigned also understands that,by Claiming additional homestead deductions unlawfully,he or _
she may be liabl; 0 back taxes and substantial financial penalties.
Owner 1 I /Date
Ari PART 4: ADDITIONAL INFORMATION - .
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT./STANDARD DEDUCTION
State Form 5473 (R215 -92)
INSTRUCTIONS: See reverse side for filing instructions.
Ti YEAR
'5 FEB 41993
CERTI ICATI STATEMENT
L(W rtify that on the 1st day of March, 19
I (We) occ as ourmthe residen describe real pro Property Tax Credit is hereby claimed:
n I ( e) owned under contract .
��iave a beneficial y that is liable for th e property taxes on the property and that owns the property or is buying under a contract.
•
CONTRACT RECORDED
If buying on contr Fee Sim le owner's name
Recorder's off Record numtx% Page
11! .
' PROPER
IPTION
Township
County
Township -
Taxi dt trict (city, town, to
hip)
nt
r ss number and street, city, state, ZIP code) '
R f_ z o 7-7197-719-A �-A PelPeC;,,v , LL Q7 b »
/ � _
—��d. pf CO� —Q�j
Parc er c ,
Legal description
NE �1�J_.
_ _
It any portion of the residenti'h1ructure or the land not exceeding one (t) acre that immediately surrounds that structure
is used to produce income, describe the use and portion
of the property utilized to produce income.
Residential improvements
Dwelling
(4)
-7 -,4
PROPERTY OWNED BY CLAIMANT'iN' F1 COUNTIES
County
Township
County
Township
I ,hereby certify the above statements are true, correct and complete.
(1)
nt
r ss number and street, city, state, ZIP code) '
R f_ z o 7-7197-719-A �-A PelPeC;,,v , LL Q7 b »
ASSESSOR USE ONLY ,.
- -
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Date signed
.
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)
I hereby certify the above is true, correct. and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
�- STANDARD DEDUCTION ALLOWANCE - -
19_ Pay 19_
Lesser of 112 Homestead
S
aluation or 52,000
Signature of Auditor
Date signed