HomeMy WebLinkAboutHomestead_Kisselo .2 CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION
State Form 5473 (R614-0.3) HC10
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing inslruclions.
it:hr.3 ' f` �"CERTIF. ICA710NSTATEMENTX',i=.*l''-.1;,
I (We)- certify lhat.on- dte..15Lrof
I (We) occupied as our pdndpal place of residence the following described real property for which a Homestead PropArtar 3 Uredit is hereby daimed:
❑ I (We) owned ❑ Are burying under contract IP�I KK 564
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns/9 property or
If buying on contract, Fee Simple owners name
where contract is recorded
Record number I Page
.ss- -'ice.. �• £+. yG., j- .. _ .... _ _
_-_ __ .._ - - _ _
ROP, ERT .YDESCRIPTIONs�:�.Ya:�,.,.c�'
County
Township
hereby certify the above statements are We, correct and complete.
Taxing district (city, town, township) "
Parcel number ^'
O 1 CO
Legal des ption
"ASSESSOR'`USE ONLY azz='.r,ZrCY
'
Is the property in question:
0O
NON- RESIDENTIAL:
{¢'`�VALUEr
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
❑ Real property ❑ Mobile Home ( /.C. 61.1 -7)
If any portion of the residentlal structure w 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.
2`
'_v yf
>' "" E:„" P, ROP.ERTYOWNED`;Bl!CLAIMANT;IN'. OTHER' COUNTIES`,.,- �: >j's?3..'.yA'°r'+"z
County
Township
County Township
hereby certify the above statements are We, correct and complete.
gnature of claimant
r
/
Address (number and street, city, state, ZIP code)
1A J
"ASSESSOR'`USE ONLY azz='.r,ZrCY
s TRUETAX� ts<
,VA_L_UE "e�' -`
-%ems -A.,.
ASSESSED VALUE
AT 100 °A °OF'TTV.4
rse. +✓.,Nn.. .N
HOMESTEAD
VALUE "
�-a �RMYr�.
NON- RESIDENTIAL:
{¢'`�VALUEr
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
2`
Tdal land (line 1 plus line 2)
(3)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Dwelling
Garage
(4).,c
O
VR C it t° Y€ r T
c
idi
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 Plus line 7)
(6)
I hereby certify the above Is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
« 'v?'w" -« _.,ro�s STAN 11A R U. DEDUCTION "ALL OWANCE..,m;°.,
20 _ Pay 20
Lesser of IQ Homestead
Valuation or $35.000 $
Signature of Auditor Dates n ¢p-��
STATE FOR M!l tt 1ICI YNI TRFANRLR FORMA,
APPROVED BY SPOT BOARD OF WYRMa.2ns FRISCIUDED BY 111E DFYMMEaH4 LrsALGOVERNMENT FENCE M to-.I-`V.1
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 becomes
more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher In bills for all:therefore.
II HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recebe the
benefit and to provide additional identifying information Accessary to allow county government to better manioc homestead
filings.This information will he kept confidential and can only be accessed by authorized county officials.The Ikpanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Kissel Leo H/Florence R Trust
101 S Ilaven DR
- Haubstadt IN 47639-811 I
7387
Leo H Kissel
101 S Haven Dr State Parcel Number Legal Description
HAUBSTADT IN 47639-8111
'1'I t"t t l't"I l l t"1'1't l'I t'I t l l"t l t"111"" "111111 26-18-36-404-000.123-009 013-00123-00 WEST HAVEN 2
•
PART 2:TAXPAYER INFORMATION
Owner I 1.?"?...-0 First Middle Last
ng Addresumber and street,city,state,and ZIP code)-
• - — - --El Same az property eddies -- -
C/J / .S. 91(--0 n ren",.n_n_- cuJa-itr -f- - y763G -3S//
Spouse First Middle Last
dlirl tv.CA— fit l
Mailing Address(Number and street city,state,and ZIP code) ❑ Same as property address
/a/Sr Ha-u , 60,1-- Neva , -. y7o3 9- 7// /
'
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 ' 2 O'S o/ '
. PART 4:ADDITIONAL INFORMATION
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