Homestead_Weber (8) MATE FORM!3Moft:I rw, RIASUREMORM:5-IA
VrfiWEO BY MATE FICIARDOF ACCIANTL!ors ptEYAtlmD BY THE DEP/L Mf-Yr(rt LOCAL CA>rtYMMT FINANCE 1C11-1.1-2:-$.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 eter for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
® HEA 134-1-2009 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 kepi confidant?'and can only be accessed by authorized county officials.The Depanntnnt of
local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Weber, Phillip S
Po Box 102
Itaubstadt IN 47639
3086
Phillip S Weber
302 N Vine St State Parcel Number Legal Description
HAUBSTADT IN 47639-8178
26-19-31-301-000.443-009 013-00443-00 ORIGINAL PLAN 94 PT/95
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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: TAXPAYER INFORMATION
Owner 1 First Middle Last
Q�SUSc' SLOTS
g Address(number and OW,city,state,and ZIP code) Same as property address
30t p, US,W{ Si, I15cAscAU( I ,J s 116m
Spouse First Middle Last
Mailing Address(Number and street,city,stale,and ZIP code) ❑ Same as properly address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
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 1 Signature Date
PART 4:ADDITIONAL INFORMATION
AJ
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION Ncfo
State Form 5473 (8614 -03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See mvsrse ado b OV nebu tiom
I (We) certify that onn tee13Tdaym+aarw,.eo_
(We) as our principal pla of residence the following described real property for which a Homestead Properly 7�t, Cr�d�(i 2006 hereby claimed:
I (We) owned ❑ Are buying under contract
JHIV U j
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propenp<y -;ys buying,un era contract.
�. ,
If buying on contract, Fee Simple owner's name
Recorders ofioe where contract is recorded
Record number I Page
�� a{-- .,,�.�:sr?>.�Gt -, "�':m7�•Ea�°�tPROPERTY, OWNED' IBYCL 'AIMANT.II.1'OTHER`000NTIES E`.�.7t:`i?•� -, .-`t'4 ^,!"'�°'.r„�s{
MAa,P.ROPERT',DESCRIPTIC+NR:`=
County
To mship
Taring district (ci ,mot lawurhol
aT2mbar
Op QW 3 -p
al description
Is the roperty in quest'
ecru property Mobil. Homo (I.C. 61.7 -7)
H 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 portion
of the property utilized to produce income.
�� a{-- .,,�.�:sr?>.�Gt -, "�':m7�•Ea�°�tPROPERTY, OWNED' IBYCL 'AIMANT.II.1'OTHER`000NTIES E`.�.7t:`i?•� -, .-`t'4 ^,!"'�°'.r„�s{
County Township
County T —nship
ereby certify the above statements are true, owed and complete.
Si ature otdaimant
Cn1
Address number and street, city, state, ZIP code)
U 43- .J 476
5
rA
' „C,ys.7r;r •r,•yux,,., ,rr: ra,'
'�'TRUETAXh'r, vet
, rVALUE Yi ;ys
ASSESSED VALUE
FAT{ 700 6:OF TTV-.
vHOMESTEAD +°
. = VALUE+ , '
NON- RESfDENTIAL )i
W'�a_a..V/U.UE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
-cot{ 1. !" •N'
Otherland
(2)
4
f �sn
Total land (line 1 plus line 2)
(3)
Residential improvements or Annually
Assessed I I I Manufactured Hone
Dwelling
Gara a
(4)�•'
rcc4m#"r -y
fflm W 6- 4119 ta.
r') t�
Other improvements
(6)�
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above Is We, owed, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
.<. x,= x• i ` - �.' -._mo t a OOMANCE C ',✓ ;�y -4';;: e,' p 5' ,"�'� iy�''.'
20 Pay 20_
Lesser of V2 Homestead
5
vauetiorl 0535.000
Signature of Auditor
Date signed ,