Homestead_Weiss (4) LIAR FORM 53 Me DC I Y+n ThLASU&LY FORM TSIA
APPRMED BYS1ATE enkRo M'.M-TT.;NTx.II ERTS[N2m BY THE DEPARTMENT°,LOCAL GOVERNMENT FINANCE IC 1.11-1174 Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and martini couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ner for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filintvs. this information will he kept confidential and can only be accessed by authorized county officials.The Dcpanntcnt 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
Weiss, Leo R/Sandra K
104 S I laven DR
tlaubstadt IN 4 763 9-8 110
7409
Leo R Weiss
104 S Haven Dr State Parcel Number Lezal Description
HAUBSTADTIN 47639-8110 •
I t� nn11111111�n�un��nt����II r��u n�n��t rr�� 26-18-36-404-000.305-009 013-00305-00 WEST HAVEN6
n11nt1t11
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Lto /2 wg> .SS
eig Address(number and street,city,state,and ZIP code) [Same as property address - — - -. — --
jot/ S, l�ilrti .OR /7:4'G'SST,ia7 7ifi zi 76 3 9
Spouse First Middle Last
-
A) 0/11 Dt.esisep
Mailing Address(Number and street,city,state,and ZIP code) ❑Sane as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
saw
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 Si onto Date
( )
PART 4:ADDITIONAL INFORMATION
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Forth 5473 (R614-03)
Proscribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse aide /or riling instructions.
YEAR
co
AAAV
. • i 1
_n
I (We) certify t �2n theIst daof laich, 20
I (We) occupied as our principal place of residence the following described real property for which a Homestead Propert�7akr @iebl6ih'ttereby�an( —me d:
'5131 (We) owned ❑ Are buying under contract
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'RECORDED ti' -.—^ x. t: f� t•Si.�Y:n��'�°.tK
-- -z:a<d x � er-
If buying on contract, Fee Semple owner's name
Recorder's office where contract is recorded Record number Page
p si•+N =r^tr3 '^'1 1P,ROP,ERTY�OESCRIPTION, "' _ `r -+PF- !"
_,i .i;.. �.... a -.vxn - ,- .1:ir;£rca'z• °..gY`
County
Tavnship
Taxing istrict (city, town, township)
Parcel number Q -�
LLegV escr ip�t/ion /
�+--r /L`7
Is the propequestion:
Real property ❑ Mobile Home VC. 61.1 -7)
If 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.
06 8 -3�- 904 — 000. 305, �i
•.�r_ �a
County
Township
a HOMESTEAD rd
VALUE
County
Township
I hereby certify the above statements are true, correct and complete.
Valuation or 535.000
Signature of c imam
W „
Address (number arM slree4 city; state, ZIP code)
10 �l
//v
1-176,31a- P110
5y - �1•afL.�cl
°" mac-- ASSESSOR USE ONLY • r s 4 '
V :•n -. �t „
f s..,y+TRUE TAXxr s
„VALUE=°
ASSESSED VALUE
AT 100h OF TTV
a HOMESTEAD rd
VALUE
NON RESIDENT[A -�
F
Land not exceeding 1 (one) acre immediately
5
Valuation or 535.000
g.
surrounding residential improvements.
Other land
2
aY
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
'..s.
''Residential improvements or Annually
- yc..M.x,'ae��rdY_;
Assessed Mobile I Manu(atlumd Home
Garage
(5)
�I Other improvements
(6)
a'V^sSfrr
4F)�
74 fg.
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(g)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
. s' .c�`,r. •=. ri'•e'Snrr'�w, v u Al-,aSTANDAR.DEDUCTIO,ALLOWANCE' r r
qW 20_Pay 20_
Lesser of 12 Homestead
5
Valuation or 535.000
Signature of Auditor
Date signed
T-1 Ir -W if -T�