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Homestead_Heldt 'SAlt r WRa.l`n,0./f+w nnrsSc nl FORM'MU .VFMR'En nr Mar.WARD Of-Mn*,.srS.Ti+ eRr3Alhm BY TIM DFPARncc OF LOCAL no%ttMMrri FINANCE IC Vel!4.t 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 tier for homestead fraud.Homestead fraud causes higher tax bills for all:therefore. HEA 1344-2009 requires uspayers who receive the homestead standard deduction to verify that they are eligible to=else the benefit and to provide additional identifvine information necessary to allow county eo eminent to better monitor homestead tiling..This information will he kepi coati-mint and can only he accessed by authorized county officials_The Depanmatt of Local Government Finance sill use this information to create tools that will help county officials eliminate homestead fraud. PART 1: PROPERTY INFORMATION Taxpayer Name Property Address Heldt, Ervin D/Shirley A RI O FRANCISCO IN 47649 1115 Ervin D/Shirley A Heldt 7650E 400 N State Parcel Number Legal Description FRANCISCO IN 47649 26-06-21-103-003.265-017 009-03265-00 Pt Sw Nw 21-1-9 7.50 ac ' Spouse First Middle Last SA . elf y A,vft ffeLd T Mailing Address(Number and street city,stale,and ZIP code) ® Same as property address 76 ,5 o E. 110041. rpphe scut, IA', 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. PART 4: ADDITIONAL INFORMATION CLAIM FOR HOMESTEAD PROPERTY TAX i FORM YEAR CREDITISTANDARD DEDUCTION HC10 State Form 5473 (R6 / 4-03) Prescribed by the Department of Local Government Fewke owns the p6jWftRr g(PWil`1V6jd MT6VbacL g _ ,r��ra,.cN�'.'�`e`'�•l,�inwa< CONTRACT .'RECORDED- '�'t,�r,•� If buying on contract, Fee Simple owner's name Recorders office where contract is recorded Record number Page .'�' i' j3�vr�,a�__ ! ;_ ;,?PROPERTY,�ESCRIP.TION "�S.'.rt':Us ?rr�"✓ a ""_s€ ,.mss, '.� r 4 +', "°ti ;. Co Township Taxing district (city, town o h" ss (number and street, dry, state, ZIP code) i P cabs jj•�� Legal description 1 Is the pro 1 uestion: zfs -Ll, eal property ❑ Mobi omo (LC. 6.1.1 -7) If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that stlucture is used to produce income, describe the use and portion of the property utilized to produce income. P, R6P. ERTY, OWNEDIBYCLAIMANiJN6THER` C6UNTIES��.,:, _..:?FF�.>~:c ?.- *�,r"z'i5r`t��3 County nship County Township 1 hereby certify the above statements are We, correct and complete. Signature of claimant ss (number and street, dry, state, ZIP code) i f Yc.J {3 i.GX.- 0z- ASSESSDR,USE ONLY TRUE TAX_,g ASSESSED VALUE 4.. HOMESTEAD, Z _ rNONtESIDENTIAL ?;n A�•yv�`.ry }_.,�,°i- �{'r_VALUEH "AT.700Ye'OFR'TTY . y yVs.VALUE `���VALUE'�;Y` Land not exceeding 1 (one) acre immediately surrounding residential improvements. Other land (2) �58 Total land (line 1 plus line 2) (3) 'Residential Dwelling (4) �.� ..q� 3i• .�;t +`? Improvements or Annually : .,uasAaEa ic:� Asseeaed Mobile/ Manufactured Home Garage (5) -;.. -. -:' Sc . .'Sri: Other improvements (6) } i�r7i � z�C" Total improvements (line 4 through line 6) (7) Trial value (line 3 plus line 7) (S) 1 hereby certify the above is true, correct, and Signature of Assessor Date signed complete. Verifying action - Signature of Auditor Date signed ; , �`+ rr?r`?#` ?`{ 5TANDARD !DEDUCTION'ALl'OWANCE';xi, 20_Pay 20_ Lesser of 112 Homestead Valuation or 13Z.000 $ Signat of Nl Date sigrtCd ` � 0 ` 5 /1 6