HomeMy WebLinkAboutHomestead_Burchell S TAM FORM 5,!`t•Iq_t,`wr RFASURm FORM SIA
AMIN-WED BY CIVIL BnARDOrAryy*oTS.yn PRLAIUBmaYmr DEPARTMENT it LOCAL GIKrRNYMrxTsDascER'LI.I-r-LI
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple are limited to one homestead standard deduction.As the receipt M this deduction becomes
more beneficial,there is more incentive than tier for homestead fraud Ilontestead fraud causes higher tat bills for all:therefore.
® HEA L344-21109 requires taxpayer who receive the homestead standard deduction to verify that they arc eligible to Ieceise the
benefit anti to provide additional identifying information necessary to allow county government to better monitor homestead
- filings.This information will he kept confidential and can only be accessed by authorized county officials.The t)e anmalt of
Local Govenmient finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY LNFORMATION
Taxpayer Name Property Address
Burchell, Martin L
107 S 4tn AVE
Ilaubstadt IN 47639
8252
Martin L Burchell
107 S 4th Ave State Parcel Number Le2a1 Description
HAUBSTADT IN 47639-8218
Itlnllntlt llnulirlrinlulntitlntllInitllnrlu tlt1t 1rl 26-19-31-304-000.153-009 013-00153-00 E PARK ADD 43E/439
Spouse First Middle Last
Mailing Address(Number and street,city,state,and'LIP code) ❑ Same as propene address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
.cue
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
r
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t i
A-177„a
PR ; y/2010
Cf
OIBSON 1.400117'( MJ I' A
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473(R5/ 10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
CERTIFICATION STATEMENT
FORM F YEAR
I
JUL 2 6 2002
I (
11661-fave 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.
'-CONT RACTi RECORDED N
If buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
K=zt '-!7 --f- I I _ PROPERTY OWNED BY CLAIMANT iN OTHER-COUNTIES
'Township
County
-PROPERTY DESCRIPTIdN
County
Toomship
�ASSESSCR� USE ONLY�, pr'4 11
-�� _� 1, 7
T district to", to nship)
I
Par I number
L Ide ption
-�13tll s the p ropea/y%.estion
��
4, ,ress(nuT
14 4 4 6s rA 6T
D9. Real property ❑ Mobile Homo (I.C. 6-1.1-7)
If any portion of the residential structure or the Land not exceeding one (1) acre that immedialely surrounds that 4uaicuire is used to produce income, describe the use and Portion
of the property utilized to produce income.
surrounding residential improvements.
Date signed
K=zt '-!7 --f- I I _ PROPERTY OWNED BY CLAIMANT iN OTHER-COUNTIES
'Township
County
nship
HOMESTEAD`
County
�ASSESSCR� USE ONLY�, pr'4 11
-�� _� 1, 7
I hereby certify the above statements are true, correct and complete.
'AT,100%0 TTV�
Signature of claimant
and street, city, state, ZIP code)
Land not exceeding I (one) acre immediately
4, ,ress(nuT
14 4 4 6s rA 6T
-
;a
!�-TRUE-TAX'-
ASSESSEDYALUE
HOMESTEAD`
"r .4j NON RESIDENTIAL"
�ASSESSCR� USE ONLY�, pr'4 11
-�� _� 1, 7
VA�UE !, 1.
'AT,100%0 TTV�
:VAI E�,
VALUE k ;�5
Land not exceeding I (one) acre immediately
Valuation or $6,000
Signature of Auditor
surrounding residential improvements.
Date signed
Other land
`
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements
i7V'
Garage
(5)
Other improvements
(6)
Total improvements (fine 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STAN DARDMEDUCTION AJ-LOWANCE,t"
20 Pay 20
Lesser of 112 Homestead
Valuation or $6,000
Signature of Auditor
Date signed