HomeMy WebLinkAboutHomestead_Ellerbruck (2)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (RS 110-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
-CERTIFICATION STATEMENT-,
I (We) On e4A0 zs E_ He,,� r- �o 4
1 (We) occupied as our principal place of residence the following described real property for which a F
❑ I (We) owned ❑ Are buying under contract
Olave a beneficial interest in the entity that is liable for the property taxes on the property and that
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded
YEAR
FORM
art III: on tqp I � d o arch, 20
_j 0
tela Property =r �, it "1sfhereby claimed:
APR 2 A 2002
the property oris buying under a contract.
Record number I Page
PkdPEiitY6WNE6BYCLAIMXNTINOTHER'COUNTIES,."4 -1n-'--,,'
Coun
6
Town
to
Taxi� dlstricl (city, ".
I
5 oA)
Signa(ure of claimant
o ih e r U'toirnlr'p
Parcel number
Le I de�ign
Is the property in question:
02-0 onp 4Q,"
L� Q, _ 3_ IT 4a-A,1
[ F t property ❑ Mobile HMO (I.C. & 1. r-7)
If any portion of the rosidenfig' 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.
Land not exceeding I (one) acre immediately
PkdPEiitY6WNE6BYCLAIMXNTINOTHER'COUNTIES,."4 -1n-'--,,'
County
Township
County _Taqnship
I hereby certify the above statements are true, correct and complete.
Signa(ure of claimant
Wross (number and street, city, state, ZIP code)
-4QASSESSOR'USE ONLY _Z
T
TRUE 4TAX
ASSESSED VALUE
VALUErk�
'N NON.RESIDENTIAL
ji i.4;1 .1
Lesser of 112 Homestead
X
�T,1990�6 OF;I7V;
-'
.. �'zVALUE_
Valuation or $6,000
-r
- - -�t-
Land not exceeding I (one) acre immediately
Dale sign
tr
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
O0 Z_
Residential improvements
Garage
(5)
g.
- fe
Other improvements
(6)
Total improvements (line 4 through line 5)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARDf.DEDUCTION
20 _ Pay 20
Lesser of 112 Homestead
$
Valuation or $6,000
Signature of Auditor
Dale sign
• STATE FORM 53569(4/&1% TREASURER FORM IS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.EON PRESCRIBED BY THE DEPARTMENT OF LO CAL GOVERNMENT FINANCE le 6-1.1-214_1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
401 N. Main Street Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
Princeton,IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore.
r T T HFA 1342-2009 anprovide requires taxpayers who yinghic the anon ec standard llow county to verify that they are r monitor or homestead
the
benefit and to prrnide additional identifying information necessary to allow arounry gmommrnt to better moni,or homatcad
5 filings.This information will be kept confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
APR 5 2011 PART I: PROPERTY INFORALATION
C - TazpaYer Name Location Address
Ellerbruck, Walter A/Cleatis
GIBBON COUNTY AUDITOR MAIN/ADAMS ST
SOMERVILLE IN 47683
8624
Walter A/Cleatis Ellerbruck
IIIIIII:.11lllll1i1 IIIILI11I alliif till _IIIIIIOD'iIIIIIIIII Ili liiiiilMiiiillliil—
Box 296 ' - ,
Somerville IN 47683-0296 .
II'IIII'I'I'I'I'II'IIIIII'IIII'IIIIIIIIIIIII"III1111111'IIIIIIII State Parcel Number . Legal Description
26-20-02-403-000.042-003 / PT SE 2 3 9 1.00 AC
i'
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: TAAXPAI'F,K.INFORMATION - _ -------
First Middle I Last
Mailing Address(number and street city,state,and ZIP code) • ❑ Same as property address .
Q t bb `C as L -3 o 3 u . ina:t i ,Soon-e rs 11,e. . ,.J 7hg�
Spouse First Middle Last
k•e-6j , s f Eilend t^ac/(
-
Mailing Address(Number and street.city,state,and ZIP code) - - 0 Same as property address
9. ?o X 3aS W : INDejl a th .e -r l 1j 1-e 41v f 7 6 .
u
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 beliable for back taxes and substantial financial penalties. • ' ' .
Own (] : G y(��
/
PART 4: ADDITIONAL INFORNIAI'ION 1 •