Homestead_Ziliak (7) MATE 1 ORM.43Yw 1P2 I LN'1 TPL'NREA fORM TS-IA
APPMlEn BY ctAIL PA DM MYYEN15.1,x PAM-BIDED BY nn:nMIMItor LOA]G%2R.VMR.T FDA%CE M4-1.1-_41.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standani deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than eser for homestead fraud.Homestead fraud causes higher tax bills for all:d;:refore.
® HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receue the
benefit and to provide additional identifying information nece aary to allow county government to better monitor homrestead
filings.This information will he Art confidential and can only be accessed by authorized county officials.The Drpanment of
Local Government finance Bill use this information to create fiats that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Ziliak, Randy L/Jamie B
P O Box 305 (��
14aubtadt IN 47639G
8183
Randy L/Jamie B Ziliak
P 0 Box 305 State Parcel Number Legal Description
Haubstadt IN 47639-0305
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PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
.a1.thiN L 1�i z, 1 ;c .�
�tg Address(number end stray!city,sate,and ZIP code) I I Same as property address -
Ica E C5ms-ic I-\c.u\-,5l-cEd* t 4-4-7(D3c:\ Pa 3oc
Spouse First Middle Last
- ---JGr•te_ Z- 1 ;cJc
Mailing Address(Number and street,city,state-and ZIP code) ❑ Same as property address
1o°‘ G Gk■osoN_) \\C U■OCMC3* T ) Lk ico3c3 Po 3os
__
Each undersigned certifies,under penalty of perjury.that the above and foregoing infonnation 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
u fully,he or she may be liable for back taxes and substantial financial penalties.
()woe I Signet Date !
i
°E CLAIM FOR HOMESTEAD PROPERTY TAX
.
7
CREDIT /STANDARD DEDUCTION H
State .FOrm 5473 (112 15-92)
wi
INSTRUCTIONS: See reverse side for filing instructions. FEB 1 -1993
CERTIFICATION STATEMENT
I (We) %1ML o_ � - certify tf/a6hi y of March, 19-1 J
I (We) occupied as oukkrincipal p a e of residence a following described real property for which Homestead Property Tax Credit is hereby claimed:
❑ ' " fe) owned ❑ Are buying under contract -
_� e 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.
[I
CONTRACT RECORDED
It buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRI
ON `
County -
Township
Township
I hereby certify the above statements are true, correct and complete.
-Taxing i
dct (Gty t
con, to n hip) •
Parcel number
_ Sfl
Legal descdpti n
N 31.3
It 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.
Total land (line 1 plus line 2)
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
ss (number and stree/. dry. state, ZlP code)
10 9 C47(Qcl
ASSESSOR USE ONLY -
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2) -
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plis line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 1/2 Homestead
Valuation or $2,000 S
Signature of Autlitor �Vl (� • tN r1 1 Date sipne'