HomeMy WebLinkAboutHomestead_Salemie HAit,ORM'31e•Ile/MNI lRFASUt[A FORM YIA
RmaIMPORTANT NOTICE TO DEPARTHENTOF LOW' .
OPERTYROWN FINANCE
ERS t 'JI
Gibson County Auditor
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 e'er for homestead fraud.Homestead fraud causes higher tax bills for all;therefore.
to NEA 1344-7009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifrina information nemsary to allow county government to better monitor homestead
things.This information will he kepi conlidenuial and can only be accessed by authorized county officials.The Depanntent of
Local Government Finance will the this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Prnperty'Address
Salemie, Guillermo S/Christie M
407 W Kentucky
Princeton IN 47670
1443
Guillermo S Salemie
407 W Kentucky State Parcel Number Legal Description
PRINCETON IN 47670-2851
Irlullnrlrllulnrlll IIr,InIJun1111nJurlrrllrl 26-12-18-103-0 J02.162-028 019-02162-00 PT NW 18-2-101.44 AC
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2: TAXPAYER INFORMATION
Owner I First' Middle Last
ChriSVI miehd c rni�
• S� Ie
m Address(number and street,city,state,and ZIP code) NI Same as property address
H 01 13 . Ven+uc14i Si. PrinCei-nn, Tnl X17vio
.
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)
_. ._ sus __ _ _ __ _
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.
Os er I ignatare Date
�� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sta�e Fwm 5473 (R614-03)
Prescribed by the Deparlmenl of local Govemment Finance
INSTRUCTIONS: See revcrsc side /or /iling Inslrucfions.
�77/��------ FORM YEAR
�J� � � HC70" t "�
� � :_ , �t y
� � � �
DEC 10 200.3
� �
i;
� M�e) �aFOn;theAst dayof Maich, 20
•� .-.D.,J�! �.OIU�i � �; "1
I(We) occupied as our principal place oi residence the following described real property (or which a Homestead Property T�i Cr�Els hereby daimed:
❑ I(We) owned ❑ Are buying under coNract
� Have a benefidal interest in Ne entity that is liable for ihe property taxes on the property and tliat owns the property or is buying under a wntraG.
If buyiriy on conVaG. Fee Simple ownefs name
Recordefs ofice where wniraG is recordeA
� �?; �'_ `� ?� - � `� Y x: ��� �? ? ."�, � , �� �� n
Counry . � Toxnship
a
7�ting distriq (ciry, tawn. towns
Record number � Page
rcra cer �/�/ 1-� �y� � ae qn /]��. J^ 1 � e property in ques6on:
( —DV�I O��W / UCJ� lO , /, ❑ Real7ropeM ❑ MobileHOmo(I.C.6i.1-7)
N any poM1ion o/ the resitlentlal sWCNre a Me Wnd not ezceetling one (1) aae Nat immediatey surtounds that swcWre is used to pratluce income. desrriba Ne use antl partion
of the property utiized to produce iMOme.