Homestead_Burchell (2)pi
i
CLAIM FOR HOMESTEAD PROPERTY TAX - - Fono _ YEAR
CREDIT /STANDARD, DEDUCTION _ q�
:.
Stave Form 5473 (R2 t 5-92) "c'
KL !/ Li
INSTRUCTIONS: See reverse side for tiling instructions. _ ��gg �J{{Y . `_ 1995
- - -
V _LQ
.1 ° Je) occupied as our principal place of residence the
X certify that on theA J - X
sru,, h 119�5
described real property for which a Homestead Property Tax Credit is hereby claimed:
t
l(We)owned ❑ Are buying under contract -
Ll 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.
`'' - CONTRACT RECORDED - -
r '$. =r arM r- •....:•rc '. trt-ty - tdmu *"� :?1rP.' . _. .._..- -_ _.n(�z<s^z +•vE.m 3is'v c <s�•A+.h. -_a s+ l.' - .�.6 -... n.+
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Record number Page
' - PROPERTY DESCRIPTION -
County ' - -
Township
County
Taxing is
rkt (city, town, town pup)
Parcel number
Legal descrip 1 n - l.v� i 4 `
If any portion of the residential structure or the land rut exceeding one (t) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
` PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES - -
County
Township
County
Township
ireby certify the above statements are true, correct and complete.
Sig
Address (number and street, dry. state, ZIP code)
Q1 s9 -4 S- 4 d/- Z,(/
ASSESSOR USE ONLY
-
TRUETAX
VALUE -
ASSESSED
VALUE-
HOMESTEAD
-VALUE-
- NON - RESIDENTIAL
`VALUE
Land not exceeding I (one) acre immediately
surrounding residential improvements.
-
Other land
(2)
-'
Total land (line I plus line 2)
3
1 .
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
- -
Total improvements (line 4 through line 6)
(7)
' value (line 3 plts line 7)
(6)
I hereby certify the above is true, Correct, and
complete.
Signature of Assessor
Date signed
Verityi g anion - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
SLUE FOAM!IV+ice/Wu, IAE1nl11.2 LOIN:}IA
'JIRO%ED BY RATE GUARD OF.rfA.S75,2 w PUSttEBm BY Mr OPPARTWENTUFLCKAL Con[a.VMrA-r re&sCE IC 41.1-2Zt.1
Gibson Courtly Auditor
101 N FAain IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead snndald deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than ever for homestead fraud Homestead fraud causes higher tax bills for all;therefore.
• ILEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they arc eligible to recent the
benefit and to provide additional identifying infomtmion necessary to allow county government to better monitor homestead
filims.This information will be kept conlldemial and can only he accessed by authorized county officials.The Ikpannaent of
Local Government Finance will wit this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Burchell, Vicki J
109 S Campbell BLVD
Ilaubstadt IN 47639-8162
2696
Vicki J Burchell
109 S Campbell Blvd State Parcel Number Legal Description
HAUBSTADT IN 47639-8162
IIIIIIItrr• .• trrllrllllrltrl rr lr'Ir II1111IIIII111III11IIIIrI 26-18-36-401-000.654-009 013-00654-OO WEST HGTS 4TH ADD 15
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
0 r C - r-CA P !i
Ong Address(number and street.city,state,and ZIP code) :15r Same as property address
��D9 C �� � L1/ 2/4
Spouse First. Middle Last
Mailing Address(Number and stee cit' u ... .. ame as ro env addrLv
Social Security Number(last 5 digits) Drivels License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
. __ _ see
PAR ATION - ------- ----- —
Each undersigned certifies,under penalty of perjury.that the above and foregoing information is true and correct and that he or she is eliuible to
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he e may be liable for back taxes and substantial financial penalties.
cr 1 Si turc
j /U )
PART 4:ADDITIONAL INFORMATION
•