HomeMy WebLinkAboutHomestead_Kiesel (4)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
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State Form 5473 (R614-03)
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Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instnictions.
Mz "v.:.`�..: W>Pn,"_.�.�'tis(�.-�+ -, a-'"CERTIF.I ATION STATEMENTi�i- .3`?t", ". .. -s^ -` .s'ni:k
I (We) QJ -S E cart at on the_ da ksq�e ar 0
I (We) occupied as our principal place of residence the following described real property for which a Homes te D ff�i xdal ad:
❑ 1 (We) owned ❑ Are buying under contract
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.
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NTRACT' RECORDED- �+'a,';'7',�t..
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
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0 PROPERT. Y: 6ESCRIP.TION".7«>``�-'1°r§+,°de
County
Township
Address (number and street, city, state, ZIP code)
for UfaP p y 9
Taring dis ' city, town, wnshi .0�
Parcel number
J �' QU
Legal description
VALU E
�° to':i�.- .,....m,°x.
Is the pro perty' question:
Real property ❑ Mobile Homo (I.C. 61.1 -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 potion
of the property utilized to produce income.
di�53 .4- �(''`„��'�>VROPERTYOWNEDjBY, CLAIMANT, IH; OTHERCOUNTIES ;���r,"�- f- R'�ti'„�,�''. `� ". �: �.
County Township
County Township
hereby certify the above statements are true, correct and complete.
Signatu lai t
Address (number and street, city, state, ZIP code)
for UfaP p y 9
�• -`Ta•- r "F" 3:=�y
'- :.
v,> -,.SAS ONLY, ''
TRUE TAXKK ,'OAT
ASSESSEDYALUE
�..�. +,. - b-',
HOMESTEAD
r
NONRESIOENTUILtf
ESSOR�USE .x...
_
?VALUE
100 °AOFT:fY
a- ..,A,,...:.._U.F
'�!;VAL'UE
VALU E
�° to':i�.- .,....m,°x.
Land not exceeding 1 (one) acne immediately
surrounding residential improvements.
Other land
(2 )
9`ar-
y"{s
�.-
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential Improvements or Annually
Assessed Mobile I Manufactured Home
Garage
Other improvements
(6)
Trial improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20
Lesser of 112 Homestead
Vatuabon or 235.000
0
snit FORm33,e•ou',oil T EASUall rORM 13-IA
.VIR(REO BY 57 ATE BOOR OF.Mn RISTS.`1 N PAL`%WDWDS'THE DEPARTMENT nr L(LaU GMT/Ceara FI:ANCEM..11-L4.I
Gibson County Auditor
101 N Main IRIPORTANT-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 becomes
more beneficial,there is more incentive than ever for homestead fraud.Homestead fmud causes higher la(bills for all:therefore.
40 HEA 134+-2000 requires taaprcra who receive the homestead standard deduction to verify that they are eligible to recehe the
benefit and to provide additional identifying information necesary to allow county government to better monitor homestead
filings.This information will he Lepl contdauial and con only he accessed by authorized county nflicials.The nepanment of
Local Govemancnt Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Kiesel, Tina M
207 Vine ST
—_ 8226 . __ _ _ .
Haubstadt IN 47639
Tina M Kiesel
207 S Vine State Parcel Number Legal Description
HAUBSTADT IN 47639
26-19-31-303-000.423-009 013-00423-00 ORIGINAL PLAN 207/206 PT
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PART 2: TAXPAYER INFORMATION
Owner First Middle / Last
i(704— telagrtr e
—�g Address(number and street city.state,and ZIP code)— — �0 Same as property address --— -- -
et C9r / G) V ( I/'7'r-h s7'rob- =7-'-t-, tr7C.'7 c(
Spouse First Middle Last
1)gt I'0 Lee Lq.jq t
Mailing Address(Number and street,city,state.and ZIP code) ❑ Same as property address
eU , (cet 49 1,14,,
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.
Ow CT I Signature v Date
( )
PART 4:ADDITIONAL INFORMATION •
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