Homestead_Sermersheim l • STATE FORM.3N til',tiNi 1tF.NEEA FORM T3-IA
.VMtn'EDBYST VEYUPUMM XXI%T5.`I•v pnAAIBEDBY Tot DEPARTiE`Tr nr tf:AL GOVERNMENT FINANCE MH.I-La.n
Gibson ibunty Auditor
101 N 'dain IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple,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.Ilomestead fraud causes higher tax bills for all,therefore.
• HEA 1344-2000 requires taxpayers who remise the homestead standard deduction to verify that they are eligible to receue the
benefit and to provide additional identifying information nece lzv to allow county government to better monitor homestead
filings.'this inlbrmatinn will he kept confidential and can only he accessed by authorized county officials.The Ikpannxm 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
Sermersheim, Roger/Robin Trust 3I/ 9 A/S g C-7
R21t
Oakland City IN 47660 P
4936 0 (ck
Roger Sermersheim W
349 N SR 57 - State Parcel Number Legal Description r ,
Oakland City IN 47660 �el`"
26-14-07-200-000.068-006 003-00068-00 PT NE 7 2 81.95 AC
C-1 4
1'
AI
t7
W
PART 2: TAXPAYER INFORMATION
Owner I First Middle I Last
)oger Frcd,°,nck �rm0'5Ae.1 wL
elg Aiddress(number and stnarL city,state,and ZIP code)-
351 9 N —ja4e PO a d S 7) Oa-Lk-rid (ALA"'" DV 417,4 0
Spouse First /I Middle C- Last
RO1j/ Y . 411 n e, 9, Senn EX'S )1 0--1 .'-
Mailing Address(Number and street,ciy,state,and ZIP code) ❑ Same as property address
.5,0talt ao C..brn"-t"
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
-
Serrn et 5 h P,t ern rre.i; /9 rust / p
bP-/i e-v CA t /ear's-e ale? s rn✓l P.! •C R bbre' l et*e oL
•
} CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION HC10
State Fomu 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
YEAR
(We) -4?�A S. ;-> 7 telnty that on the 1st tit MMM
(We) occu ed as our principal place of residence the following scribed r property for which a Homestead Pro Jr h e d me
❑ I (We) owned ❑ Are buying under contract y @g
Have a beneficial interest in the entity that is liable for the property taxes on the properly and that owns the prop or is buying under,gaFxract.
..xc�YcYtfFi- ONTRACT.;RECORDED_e "=�'s� -•-'�, :pw4- `+' =i*� `.'= ':
r.
If buying on contract, Fee Simple owners name `) T Y FUDITOP`
COU
Recorders office where contract is recorded Record number Page
MMAKIR,`2' r`r'$ ar<. 3V1<"�..�- .a� -A%`s" P, ROPERTY;OWNE6B'K CLAI MA- NT, IW&HERCOUNTIES.''`,rs�:.'.��_
l?ROPERT `/,15ESCRIP.TI6N?2r'"`..K, + -i°�- - �.- ..- +r''•+'"'"' �;i,E%
Count'
Say✓
Toxnshi
6�
Taring district (city , t hip)
Signature of claimant
a
. /i 2 .Q 30 A Q 76
Pa ur�lbei a� 1, ��'
al descrip�ti`on Q
Is the property in question:
'Heal
D
IJ property ❑ WNW Homo ( /.C. 61.1 -7)
H 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.
_ /% 7 -BOG
MMAKIR,`2' r`r'$ ar<. 3V1<"�..�- .a� -A%`s" P, ROPERTY;OWNE6B'K CLAI MA- NT, IW&HERCOUNTIES.''`,rs�:.'.��_
County
Toomship
County Twvnship
I hereby certify the above statements are true, correct and complete.
Signature of claimant
dress (number and street, city, state, ZIP code)
. /i 2 .Q 30 A Q 76
Date s/ig /Qed -�D
C/
-' '" a i = "'#`T�RUETAX(� 'ASSESSED,VALUEHOMESTEAD F ` NON = RESIDENTIAL
ASSE§SO�R�USE ONE i',t VALUEa "AT�00°,6-O& VALUE
&Y. rVAL'UE. � ,
Land not exceeding 1 (one) acre immediately
W NW :7i°".. - g �4t�`-c{g,�,�,
u---. ,..
surrounding residential improvements-
Other land
O 2
'
F
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
mi
F
ME
m
Residential Improvements or Annually
Assessed Mobile I Manufactured Home
Garage
9
( 5 )
,t
Other improvements
(6)
f '?
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
. STAN DARD '.DEDUCTION'ALL'OWANCEyjs
20 _Pay 20
Le ro11/2 Homestead
1
$
vaua .000
r
Signature of Auditor
Date s/ig /Qed -�D
C/
G/ -
I
J