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Homestead_Koberstein (7) STATE FORM 335t.12'f 5-WI MSCULE.R all 7.3-1A Arrnm'En BY STATE BMRO OF MTh INIS.`�r' PVYRIBFD BY PIE DEPMMEROF LOCAL C{RtIL4MOAT FINANCE IC Vr.1424.r 101 N i County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS 101 N Main 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 tier for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.•® HEA 1344-2009 requites taxpayers who receive the homestead standard deduction to verity that they are eligible to recent the benefit and to provide additional identifying information necessary to allow county government to better monitor homestead fling-This information will be kepi conlldemial 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. PART 1: PROPERTY INFORMATION Taxpayer Name Property Address Koberstein, Emory L a 2 b.Q E4YE 301 S Stormont ST ' Princeton IN 47670 3062 Emory L/ Lorine Koberstein 301 S Stormont ST State Parcel Number Legal Description Princeton IN 47670-2231 I I I I III I I I I I I I I I I III 11t I I 26-12-07-402-001.501-028 019-01501-00 PAXTON ADD 5 PT/6/7 t tt tut t tt ter ttrtt r rr r rr rtrr PT/16 PT/17/18 PT PART 2:TAXPAYER INFORMATION Owner I First Middle Last 4-moRy 2 Ko8£Rs7-Eia - ig:Addrsss(number and street,city,sate,and ZIP code) 3 Same as pmperty address._ _ ea' 5 57o4fiew7 57 / AV.4JcsrcN :EN 41 71, 7o Spouse First Middle // Last LD z<ENE /9 'KO gec s7c;n/ Mailing Address(Number and street,city,state.and ZIP code) }I Same as property address - - - - -- -- --- ---- — - - - -- - -- -- 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 FOflM HC 10 1979 PrescribM By Sure BoaM af TaM Commissioners CLAIM FOH HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�— To & FileO in WDlicate SEE BACK FOR FILING INSTRUCTIONS �l (�� Q�SOI. OD � � �(We) ��''�"4-'ti- �• �� /� certify that on the 1st day of arch, 19%rf I, (We) cupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby being claimed: I, (We) ❑ owned ❑ are buying under contract ❑ have a beneficial intere�,in the taxpayer Property Description Taxing District (City, Town, Township): Parcel Number If buying on contract: Owners �� Township or �I gal description shown on t� y[�me�� C�'�.��` �a�/Q.'�¢_ s � i V ' 1f��^�T�R/� Contract recorded in Recorders Office - Record If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that structure is. used to produce income, describe the use and portion of the property utilized to produce income Any other counties in which individual owns or is buying real property: certify the above statement is true, correct and complete. ; �oi �'d'�,..-,� > County Township �L �/ 7G 7a State an0 Zip CoUe ' Individual either owns or is buying under a contract that provides he is to pay the property taxes on the residence, or has a beneficial interest in the taxpayer. - FOR ASSESSOR'S USE Land not exceeding 1(o ac� imr�diat� � surrounding residential ir rove entsE3a Other Land Total Land _,IUNZgI� Residentiai Improvements n � _ - .-" ling � vi, r �qa�r.age �� - Tola l Other Improvements �T Improvements - Line (6) plus (7) equals (8) by cerlify the above is true, correct.�nd complete. Sigrumre o� Assessor True Cash Value �/O (�) (2) — � � (3) '`t�-�" 5�(a/G (a) L.3�-a— cs) / 9� c6) /��-e— n� — ° – �g� /3�3o J �[i�[[i7�:�/_pl1 Assessed Homestead Valuation �SSo Valuation,�,$� � � �- ig-�y Date Approved: ��, �� Date: � — � � '� ��