Homestead_Birchler "Au roe,!H12r,w1 TPIASOAER FORM SIA
APPROVED BY MATE YHRDIu N„i1MS 9n PRESCRIBED BY TIE DEPMMr.YT(W LIAR GOVERNMENT FINANCE IC 11.1.1-r4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individual and married couples are limited to otn homestead 9andard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than e'er for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receise'he
benefit and to provide additional identifying infomuttion necessary to allow county government to better monitor homestead -
Ham,.'Ibis information will he kepi confidential and ran only he arre_sed by authorized count'officials.The Department of 7
Local Government Finance wit' use this information to create owls that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Birchler, William A
\l( ) Princeton IN 47670
2330
William A Birchler
1029 N Main St State Parcel Number Legal Description
Princeton IN 47670-1459
I I I I III III ' I I I I I I I I III I. 26-12-06-304-001.190-028 019-01190-00 PT SE SW 6-2-10 5.10 AC
1 11 Iii r Ir fir I rr 1 1 1 1 lit 1 1 fit 11
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
1
/Jilt:/Ah /, /4cf74//4 7`t . /,4cf{L/t/r
IIIg nuw�(nutnbet oust strait.city;state;and ZIP code)-. _ _ _ .. .. .- Same as property address—_. — --— _ _ _- _
/d.?9 /i I//4//v1 .f'/ /4//zcz /O� .L/''J y 7 y,
Spouse First Middle Last
Mailing Address(Number and street,city.state,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
Scut
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
•
,�E=^•rF -
:
e a
:��%i
_ �
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITlSTANDARD DEDUCTION
State Form 5473 (R2 / 5-92)
INSTRUCTIONS: See reverse side �or liling instructions.
FORM
HC70
YEAR
CERTIFICATION STATEMENT
I(We) � ��C/�— � certify that th a� � rch, 19_
I(VJe) occupied as our principal place of residence ihe follovring described real property for which a Homestead P� Tax ereby claimed:
❑ I(VJe) owned ❑ Are buying under contract . . ''�p
❑ Have a beneficial inierest in the entiry that is liable tor the property taues on the property and that owns ih p or is buyR�der a co act. '
11 ,:•-
CONTRACT RECORDED E1
It buying on contract, Fee Simple owners name - � �y PV
U
Fecortlers olfice where conVac[ is recorded � umber . Page
PROPERTY DESCRIPTIO
Counry �'n ^ � Township �� �� Taxing dist' t�ry, tpwn, rownshi )
v�( l
Parcel num r Leqal descnption
�� —0�� C�—O
II any ponion of ihe resitlential structure or ihe IarW not exceeding one (1) acre ihat immediately surtounds ihat swcture is used to produce incnme, describe Ne use antl ponion of
Ne property utilized m protluce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
SignaWre of clai�y nt
sreby certify the above statements are true, correct and complete. ;`�/ ' ��
c{�y
Address (number and s1reeC ciry, slate, ZIP code) �
' � .� � �
ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
. VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (»
surrounding resideniial improvements. -
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential imprrnements
Garage (5)
Other improvements (6)
Total improvements (line 4 fhrough line 6J (7)
Total value (line 3 plus line 7J (8)
I hereby Certify Ihe above is true, correCt, and . Signamre of Assesor Date signed
complete.
Veritying acfion - Signature of Audimr Date signetl
• STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead � S
Valuation or 52,000 �
Signature of Auditw Date signed