Homestead_Romershausen a 1. SIMTE FORM53fta Its_/ton, TRTASUtfA f0L' TS-IA
.APPROVED BY[14Th MNO(W VvrIsTS.err'. PRESCRIBED BY mf DE?MT a r(f LOCAL CAIrbM.EKT FINANCE IC 14.1 r4.1
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 net-for homestead fnutL Ilontestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they am eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will be Lept 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 LNFORMATION
Taxpayer Name Property Address
Romershausen, Brett K
106 Ben ST
Ilaubstadt IN 47639-8120
7305
Brett K Romershausen
106 Ben St State Parcel Number Legal Description
HAUBSTADT IN 47639-8120
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PART 2:TAXPAYER INFORMATION
Owner I(� Film ''// Middle Last
Sre I 1 {C
-- eti)&-Hf- Wyn.-ee s h et44se4
along Address(number and street,city,state,and ZIP code) at Same as property address
10 Co recc=-7l.)
/
Spouse First Middle Last
D'AJP1-
Mailing Address(Number and street,city,state,and ZIP code) n Same as prepeny address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
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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 eliuible 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 Date
•
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R6 / 4-03)
Prmonbed by the Department of Local Government Fmarwe
INSTRUCTIONS: See rave= aide fior Ming itlttYtrct am
FORM YEAR
gi� HC10
L IE D
(We) certify that on the 1st day of March, 20
(We) occupied as our principal place of residence the followi described real property for which a Homestead Pro CiUl ishereby claimed:
(We) owned El Are U'.
Are buying under contract GIBSON COUNTY AUDITOR
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 'RECOR_DED= �'- ,i#r- >'%`7- -tt�
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
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?� ASSESSOR�.USE ONLY i
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ERT ._ 1?,O_ ESCRIPTIO ...
N'�?"''�.G",`� —c3=
County
County To mship
To mship
Taring district (dry, town, township)
ress (number and Street, city, state, ZIP code)
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, VALU ;� f
Land not exceeding 1 (one) acre immediately�-�,FF:y'E!?�r3%Fj
Parcel number
Leg descdptio
Is the property in question:
C>A
-11 "c
A
eal property ❑ Mobile Home (LC. 6- f.f -7)
If any porligR of the residential structure or the land not exceeding o ) acne that immediately surrounds that structure is used b produce income, describe the use and portion
the
of util'¢ed to
income.
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?� ASSESSOR�.USE ONLY i
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County
Township
County To mship
hereby certify the above statements are true, correct and complete.
Sign atur8e(daimant
`UL
ress (number and Street, city, state, ZIP code)
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VALUEf
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?� ASSESSOR�.USE ONLY i
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ASSESSED VALUE
?HOMESTEAD -.
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NONAESIDENTIAL Iq 1?
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'."A1100WOFaTTVa
VALUEf
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Land not exceeding 1 (one) acre immediately�-�,FF:y'E!?�r3%Fj
surrounding residential improvements.
Other land
n
N
(2)
.,
Total land (line I plus line 2)
(3)
Dwelling
(4)
(Residential Improvements or Annually'
Atttteased Mt160e / Manufactured Hama
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line by
(T)
Total value (line 3 plus line 7)
(S)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
�K�.E?oF��R'�^_- '��i.' 7`-��-.z�1?.'•.�1. `a'i`��L'ST/WDARU' DEDUCTION' AL' COWANCE,.> ?: g�" h. �._ ��`. i� `i�'s"1fi.;7'- ei_`%i„��(w',raR�t
20 _ Pay 20
Lesser of 1r2 Homestead
Valuation or 535.000 $
Signature of Aud" or Date signed ^ T
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