Homestead_Rotramel STATE FORM 53569(5319-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ArCOUNTS.1009 PRESUMED BY THE DEPARTMENT OF LLCALGONTANMFST FINANCE IC 6-11-124.1
• Gibson County Auditor . IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS'
101 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 hills for all;therefore,
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are 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 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.
PART' 1: PROPERTY INFORMATION
Taxpayer Name Location Address
_
Rotramel, Patrick D ' •
112 S CAMPBELL BLVD
HAUBSTADT IN 47639
2350pI II
Patrick D Rotramel II I�III.DIII III I�_IIII_Ifl1111II�IIII1110_II_IIIm I I I�II hilllfl_II I IQIIII
112 S Campbell Blvd
HAUBSTADT IN 47639-8162
I"III'li'Ilia'I"'I'II'I""ii"I'llI'II"liiltl1lll1ll11llr1191 State Parcel Number Legal Description
26-18-36-403-000.587-009 WEST HEIGHTS 3RD ADDN 312
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.
r
O. . I k f First Middle Last
?0:1-11-, L 1)0Urelas ��rrtiw.e
Mailing Address(number and street.city.state,and ZIP code) Same as property address
II ? S . Ccti.Oe i TEND Hs l�c, A - Sl✓y763q •
-
Spouse First Middle nn Last
i1CAeJ1Y1� fv • 1�0�✓�AVv o,)
iling Address(Number and sirceceitrsstate,and ZIP'code) - 'f Vl-Same as p,opertyaddaas .-. .-- , --
=. •
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 -gnaw, - Date
l
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
Sam Form 5473 (R71 SM
Prescribed by the Departrnent of Lmal Gouerrmal Finams
INSTRUCTIONS: See reverse side for piing instructions.
FORM
HC10
1,.... :,>.. .,, �, -.. . .. - ._..� %"•�., : -' _ � - r�wrlwr_sTlnueTeTCaFCUr -. �:n.;r •:,. -; u.,- � �� -�� �i -,_. -,
I (We) t2 xA 211aL 22) D/I certify that t�t da�. eldr. 20-
I (We) occupied as our principal place of residence the following described real property for which a Homestead Property yTax Credit �iis hereby claimed:
I (We) owned ❑ Are buy'hrg under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the ginglN30 tR ttraci.
',..1:. •- CONTRACTRECORDm :� .��. a. t �:. z y, +x:;+., " r aY }•[..:tSe'
If N4 *V on .,trail, Fee Simple owrefs ram _
fimmdees d5ce where corwad u recorded Record number Page
.•
PROPERTY .DESCRIt?11ON'.
Township
Carly
Tarstcp
I hereby certify the above stateRlerrts are true. correct and complete.
T --9 " (city. town, to wup)
'AT 1007E OF TTV i
Parcel nxnber
Legal dVoonpbon
`
?639
Is the property it Question: .
0pyt W.12,
surmamling residential improverrmis.
( property
❑ Mobile Home (LC. 61.1 -7)
tarry portion of the residential strmbxe or the lad net exceeding WS6
(1) acre eat mrredimbely amax,dx ten st"Aum is used to produce i,mrre, desuhbe the tan and portion
d the property Ld f®d o prod" i..
(2)
3 -coo- L5 8 -7 - � �
(o - - 3 � -tio
.. ,, PROaElrrrowNEOSYCLAainMroa "onfercour&iEsr,.:
County
Township
County
Township
I hereby certify the above stateRlerrts are true. correct and complete.
VALl1E.', ,
'AT 1007E OF TTV i
.yeat
illy, sham, ZIP
`
?639
t-,
USE ONLY
�. r TRUE TAX '
ASSESS VALUE
HNriIESTE OD
'4 NON- RFS�ENTI/1L
�`yf,
,,ASSESSOR
ri ..' ;tin a't i:.
VALl1E.', ,
'AT 1007E OF TTV i
t . VALUE t a
�, ,�' VALUE.` ^
:.fir a 4X4r s rt` sv
Land not exceedhg 1 (one) acre imamdately
; hYLfFa i 4;1" a ,Zy f 41
VIP,
surmamling residential improverrmis.
(1)
,v i3 't.rthn y i _ n.y'.s -�'" s i ✓``rr: -il-h
Other land
(2)
.s
Trial land (fare 1 plus fore 2)
(3)
Dwelling
�{.e
Residential 'vnproveen or Annually
mts
(4)
Assessed Mobile I Marndarhxed Hare
Garage
-, rz x r' 3 z y-
(5)
�',T'
u..
. :...,.
Other irnpoverrents
(6)
., -;. ;•
Trial bthprovanents (fore 4 Uvourg h fire 6)
(7)
Tdal value (fare 3 pdrs fine 7)
(6)
1 hereby rortify the abase is true, coned. and
Sunah a dASaasser
Date a'ghed
complete.
VaiMng action - Silpabxe d Auditor
Dam signed
STANDARD DEDUCTION ALLOWANCE
20 _ Pay 20
Lesser of 12 Homstoad
S
Valuation or 535,000
Signah" dNditm
Dam signed