Homestead_Weber (9) nut FOAM.!MIRE/fuMI MEASURER Po0.M gIA
.VPR(FEO BY STATE OCKAD tF MYUSn bry PU.*IRIBFD BY TIFF DFPAWxff.Yr(4 LC AL CAn2RNMra FINANCE It lt.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 ever for homestead feud Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-21109 requires taxpayers who receive the homestead standard don to verify that they bee eligible eces the
benefit ant to provide additional identifying information no c any to allow county govsmm to better moni tor homestead
1111F1 / LE
9,
filing,This information will he kept confidential and can only he 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
APR 1 9 2010 Taxpayer Name Property Address
' y�� Weber, Richard E
? fose 4 211 S Race
ceIb ON COUNTY AUDITOR Ilaubstadt IN 47639
3110
Richard E Weber 3 igcnc
211 S Race St T.O •
HAUBSTADT IN 47639 State Parcel Number Legal Description
26-19-31-303-000.373-009 013-00373-00 ORIGINAL PLAN 262/263
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 1NFORN ATION
Owner I First Middle II rr Last
I\I C, j c<cc] AJ4 e
tg Address(number and street.city,state,and ZIP code) [Same as property address
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) El Same as property address
Social Security Number(last 5 digits) Drivers Licease/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
Soo
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 / Date
•
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION Hcta
Stele Form 5173 (R6 / 403)
Prescribed by the Department of Lail Government Finance
INSTRUC ONS: See reoerm tilde IbrMV inabucbonL
_RTIFICATION STATE ENT --
a
I (We) certify that on the 1st day of March, 20
I (We) occupied as our principal place of residence the following described real property for which a HomesteArop"T2Midit is hereby claimed:
❑ 1 (We) owned ❑ Are buying under contract ma�y7�,,r� � /���!!
® Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns t4Wcpe�ty�er4a Vpying under a contract.
"
''IFr�3CONTRACPRECORDEO� -..�,
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Record number Page
0ERTYr6ESCRIP.TIONs�"r,
County
Tavnship
County Township
Taring district (city, town fo ns rp)
P I n
p n Legal
7 c 2 %( ¢r ST ��� -:77W
Is the property in question:
�oO�� l ll
3
Land not exceeding 1 (one) acre immediately.,��
eal property ❑ Mobile Homo (I.C. 61.1 -7)
If any portion of the residential structure or the Land not exceedin
(1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
..,.. .._,..:� 4,-{ti &,,,i._- -'- ,�PROP.ERTY,OWNED:BY CL'AIMANT-IN; OTHER
County
Township
County Township
I hereby certify the above statements are We, correct and complete.
S" nature laim 77
l�
ddress (number and street, city, state, ZIP code)
67 LI
7 c 2 %( ¢r ST ��� -:77W
ASSESSOR�USE ONLY
ASSESSED VALUE
xoHOMESTEAD-
N
NON-RESIDENTIAL
w }y"`VALUEx�h.
rAT�100 /._OFTfV.VALUEVAL.UEF'�°'i<r,.
Land not exceeding 1 (one) acre immediately.,��
surrounding residential improvements.
Otherland
(2)
y�y•-•�s
�i?S1'r3Y.' Y 3
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
'Residential improvements or Annually
Assessed Mobile / Manufactured Home
Garage
Other improvements
(6)��y
"Y
Trial improvements (line 4 through line 6)
(T)
Total value (line 3 pits line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed