Homestead_SiekmanCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
} CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (WeF _ RUA,— certify that on the 1 st day of March, 20
1 (We) upied as our d11 clpal place of residence following described real property for which a Homestead Pr4qperiy Tae - edit is'heeMy al d: ij
161 Is
I (We) owned LJ Are buying under contract �a--(!t ' .
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
,r_,a".y'sst r•'e ii?':; 5,•.-.. fz' a'& trcb} i` KCONTRACTRECORDED;• stie5i� ,.`tT,`r.- �'- ''},- +F*T'Fj
It buying on contract, Fee Simple owners name
ry cnn17r1�
Recorders office where contract is recorded Rew'ar`d `number Page
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SSESSOR(USE ONLYr w
R0REI1T,Y.I5ESdR(P.T16N
County
Toxnship
Taxing 7M
wnshi
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)all one
Lee`gJI escdpt' n
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-f VALUE
is the properly in question:
,(�Fteal proDeny
❑ Mobile Homo (I.C. 6-1.1 -7)
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.
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SSESSOR(USE ONLYr w
County
Tavnship
County Township
I hereby certify the above statements are true, correct and complete.
Sig a re of claims
'pjiVALUE3,
( mbar end street, city state, cod
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SSESSOR(USE ONLYr w
TRUE TAX
ASSESSES VALUE
94f6A STIJIO';`
eNO E,RESlffili AL -�
Rs4�-.'.r
a t`r+..4�r.-
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Land not exceeding 1 (one) acre immediately
(1)
�ti''`,Yi -ij"' +y"
` 7'
'rcK,`'�
surrounding residential improvements.
; _' 4
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential Improvements or Annually
Assessed Mobile I Manufactured Home
Garage
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Vedlying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
vauji6m or E35.000
3
Signature of Auditor / / CAA (' 1 L I1 „ 1 I 1 Da / Uned V_ f
ct
SIMt FORM! 4 l n:1•10 L E...SI[FA FORM 7S-1A
APPROVED BY xt%tL MUnnr NTT*INtS.Y'n PRISNRmm nY THE DEPARMENTOF LOCAL GOVELNMR.T FINANCE MVI.I-U4.1
:Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individual and married couple. are limited to one ham-stead standard deduction.As the receipt of this deduction becomes
talk—} more beneficial.there h more incentive than nee for homestead fraud.homestead fraud causes higher in bills for all:therefore.
HEA 1344--2009 requires taxpayers who receive the homestead standard deduction to verify that they am eligible to treene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
tiling..this information will he kept confidential and nn only he accessed by authorized county officials The Depanment of
Local Government finance will use this infomnation to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Siekman, Travis S/Amy D
R3 Box 133
Oakland City IN 47660
8667
Travis S Siekman
9210 E SR 168 State Parcel Number Legal Description
OAKLAND CITY IN 47660
_ _ _26-20-15-204-000.102-002 015-00102-00 PT NE is 3 s_96 AC _
x
PART 2:TAXPAYER INFORMATION
Owner 1 First Middle Last
- _�Qvl Staff- - Siena
no Address(number and street.city,state,and ZIP code) O Same as property oddr¢
yojlo & S. Pd. J( ? Oakjarld e' Y7(0(00
Spotn First Middle Last
rn Akiai Siek.rnan
Mailing_Addr (Number and street,city,state,and ZIP code) ❑ Same as property address
10 g SF. 0. la) Oakland G u, N g7oioo
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
PART 4:ADDITIONAL INFORMATION
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