HomeMy WebLinkAboutHomestead_BrubeckCLAIM FOR HOMESTEAD PROPERTY TAX
d ? STANDARD I SUPPLEMENTAL DEDUCTION
State Form 5473 (R1216-09)
Prescribed by the Department of Local Government Finance
❑ Am (are) entitled to occupy as a tenant- stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
INFORMATION
Name of claim nt (legal name)
Social4gacurty number of s1 five digits)
Drivels license I
Names of daaiimard s spouse (legal name)
Sodal Se 6ty number of dairnant's spouse (last five digas) Drivers license I Identification I Other number Issuing State
of claimant's spouse (last rise digital
CONTRACT ••r
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township Taxing district (rely. town, to 1P
Parcel number
Perry
Legs d I' u� a y � o 'MI Is ❑ Zal pro m ❑ Annually assessed mobile home (IC 6.1-1-7)
If any portion of the residential structure or the [and not exceeding tine (1) acre that immediately surrounds that structure is used to produce Income, describe the use and portion
of the property utilized to produce income.
005 - OA`s' i7
DJ- 47-
PROPERTY r BY CLAIMANT
IN OTHER COUNTIES,
County Township
County Township
I hereby certify the above statements are we, correct and complete.
Sig of imant
Address (number and street, - . state.
/
L �7
(/� �//�•�
•
ASSESSED VALUE • r
ASSESSOR USE ONLY." TRUE TAX VALUE I AT 100% OF TTV I
• r
Land not exceeding t (one) acre immediatety,
(t)
s;,,.�-
sumounding residential improvements.
• -.z ,;,'?r ;<;;v'tia.r_U
Other land
(2)
r t .=yh7
Total land (line 1 plus line 21
(3)
ZZ
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile 1 Manufactured Home
Garage
(5)
Other improvements
(6)
ti 3
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, cornea,
Signature of Assessor
Data signed (month, day, ywo
and complete.
Veritying action - Signature of Auditor Date signed (month, clay, year)
STANDARD • r
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
Nolwi hstandlrg any other provision, the sum of the deductions PmvkW in IC 61.1 -12 to a mobHe home that is 5
not assessed as real property or to a manufactured horse that is not assessed as real property may not exceed -
one- hall (1R) of the assessed value of the mobdo home or manufactured home.
Signature of Audits
Date signed (month, day, year)
.
STATE FORM 533M(Rl IMO) 'MEASURER FORM TEMA
APPROVED BY STATE BOARD OF ACCOUNTS`.(O9 PRESCRIBED BY Tiff.OFPARMEST OF LOCAL CrOVIS\MEYT RNA WE IC 63.1-221.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OW\ RS
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction As the receipt of this deductionbecomes
Princeton, IN 47670 more beneficial,there is more incentive than ever 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 arc eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
illrags.This information will be kept confidential and can only be accessed by authorized county officials.The Department of
.1 Government Finance will use this information to create tools that will help county officials eliminate homestead fraud
PART 1:m PROPERTY INFORMATION
APR 2 5 2011 Taxpayer Name Location Address
_ Brubeck, Stanley J
11030 N SALEM LN
124 • GIBSON COUNTY AUDITOR
HAZLETON IN 47640
Stanley) Brubeck IID1111I KIIlII.IKI Oil III/ Ii III [11111II iFiii01111-11111KU[IllII1 fill 11111
11030 N Salem LN
Hazleton IN 47640-9383
Iii ilillilit 11111111111111111111111111111111111111111111111111111
State Parcel Number Legal Description
26-02-47-005-000.822-01✓ PPT LOC 5 6.1-10 PT NW FR 24-1-10 5.00
5
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.
J _ PART 2: TA XPAYER 1NFOR IATION
Ov. a 1 First ^� Middle — Lag
La
dot
Mailing Address(number and 6 rtreet-city,state,and ZIP code) Ei Same as properiy address
1X030 AL iftLEM L. ti-A)&" H AtLE-1"6n1,154 `17690-93 F3
-
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
I I I I I I I I Situ
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 �c j f
Signature Date Telephone
PART 4: ADDITIONAL INFORMATION