Homestead_CieslinskiCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION I HC 10 -'i <`
State Form 5473 (R6 / 4-03) i
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
DEC io 2003
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(We) certify,that,ontthe,f st day of Marchr-20
I (We) occupied as our principal place of residence the following described real property for which a Homes / t'eadiPrZpirti,'TadCre8itislReTte-ty jaimed:
❑ 1 (We) owned ❑ Are buying under contract
N--1
k Have a beneficial interest in the entry that is liable for the property taxes on the property and that owns the property or is buying under a contract.
�-cqKTRACT...RECORDED
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
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County
County
Township
Township
T -j
nfTct (ciy, I , to-lishp)
S ax,
TAd�res,i; (number and street,
t:WCIP code)
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Parcel n_qn1ber
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I Is the property in question
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VReal property ❑ Mobile HMO (I.C. 6-1.1-7)
If any portion of the residentral sWCfure o the land not exceeding
one (1) am that immediately surrounds that stfucture is used to produce income, describe the use and portion
of the property uti to produce income-
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County
Township
County
Township
1 hereby certify the above statements are true, correct and complete.
Signature of clal an
TAd�res,i; (number and street,
t:WCIP code)
AM
WA RLY-1 ME
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Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Otherland
(2)
W-5
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential Improvements or Annually
Assessed Mobile Man ufactured Home
Garage
(5)
yam_ cr
A
M.
lot
Other improvements
(6)
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Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, coffect, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
OWANCE
20— Pay 2O_
Lesser of 1f2 Homestead
Vatuation or 535.000 S
Signature of Auditor Date signed
VIATE Inds}WW2 5.t TREASURER FORM 31A
.APPROVED BY SI OE BfwRmW ACCOUNTS.yr PtfrRWID BY mr DEPARTn.VT OF LOCAL GOVIENMLAt FP:.AyCE ICs,.i.r-..t
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction ta-comes
mote beneficial,there is more incentive than net for homestead fraud Homestead fraud causes higher tax hills for all:therefore.
HEA 1344-7009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to rreene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.'Ibis information will he Lept confidential and can only he accessed by authorized county officials.The Depanment of
Local Government Finance will use this information to create'tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY;rcFORMATION
Taxpayer Name - Property Address
Cieslinski, Michael K/ Brenda E
304 West Plum-Hwy 68
Haubstadt IN 47639
3416
Michael K Cieslinski
304 W Highway 68 State Parcel Number Legal Description
HAUBSTADT IN 47639
26-23-06-101-000.598-009 013-00598-00 PT W 6 4 10.5677 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 -- i
Owner I • First Middle /7 Last
a , ic f� C�/e.S/ ✓�s�C
ets Address(number and street.city,state,and ZIP code)
®'Same ass property address
-^-� `/ W ' S ` d /‘//4—Ste.. 72(1 `/7x03/'
Spouse First Middle Last
ear C/204 &../ e/eS/14J//
Mailing Address(Number and street,city,state,and ZIP code) `iii Same as property address
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
lia bl e for back taxes and substantial financial penalties.
Owner ac )a :::::: i (
PART 4:ADDITIONAL INFORMATION
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