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1
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION Hc10 `
State Form 5473 IRS I4-M)
Prearnbed by the Department of Local Government Famaxe
INSTRUCTIONS: See nem= Mb tbrObtp inebucdona Fil 1P T-1
opal,.,- F ` `� :CERTIF.ICATION
STATEMENTr%^-
_ -.._-
I (We) certify that on the 1st @jy Iaar�h _
I (We) occupied A our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract uI- !„ rQ �t�
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property )r is buOIJ �VOUN 1� �ITOR
W- '"'r-�^'S *a„r „- �,�,`5+ -✓: ONTRIiCTRECORDED''.xa�'.f�y
'?3rr.'; 'i``
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
"�.�'�ti:�- xs`��.=�'�*e�'ts� ��sw- ..PROP.ERT,Y, OWNED- BYCL'AIMANT_IN'OTHER'COUNTIES �+;��5���,f .'p-�e�f.�',+�^'jr:�fa'�`.'
County Township
County
Tomship
Taring district (city, town, township)
Parcel number
Legal description
Is the property in question:
O - - 01
/
A) S !p —Z —
Real property ❑ Mobile Home (I.C. 61.1 -7)
H any portion of the residendal structure or the land not exceeding one (1) ace that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
"�.�'�ti:�- xs`��.=�'�*e�'ts� ��sw- ..PROP.ERT,Y, OWNED- BYCL'AIMANT_IN'OTHER'COUNTIES �+;��5���,f .'p-�e�f.�',+�^'jr:�fa'�`.'
County Township
County Tovnship
I hereby certify the above statements are true, correct and complete.
Sign ture o1 mant
Address (number and street, city, state, ZIP code)
IF
# y"'�'"
,�v .. ASSESSOR'USE ONLY- - �'
'a i-,�.1
TRUE TAX+
' VAI:UE" s1
3. w� +
�ASSESSED.VALUEhHO1NESTEAD
AT710o% OFTTV
-.ti, aka-
� ` VALUEf
ai ":.<.,
'" ]NON= RESIDENTIAL'']^(
Tsar VALUEr=' "
_E!t4
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Otherland
Tdal land (line 1 plus line 2)
(3)
'Residential Improvements or Annually
Assessed Mobile I Manufactured Home
Dwelling
Garage
(4)
()
in _.r W „U
"``'"'
�y'"""na
#" -° ,w.-' OWN
�.ar+
Other improvements
(6)
:
Trial improvements (line 4 through fine 6)
(7)
Total value (line 3 plus 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
STANDARU :DEDUCTION'ALLOWANCEr_*i�.
20 _ Pay 20 _
Lesser of 112 Homestead
Vautroon or $35.000
$
Signature of Auditor
Date signed
STATE FORM!)'MIR-r■B1 ',SASUA1R FORM TS-IA
.Arr ROVED BY SIAM BlMPDOr MIMI.VI S.2Vx PRE RIBED BY 11111 DEPARTMENT OF LOCAL novrigonti FINANCEIC LI.I-U-I.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 fraud.Homestead fraud causes higher tat bills for all:therefore.
HEA 1344--2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive a the
benefit and to provide additional identifying informaton ncrosary to allow county government to better monitor homestead
filings.This inforration will he kept conllde tint and ran only be accessed by authorized county officials.The Depannlem of
Local Government Finance will me this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Kixmiller, Benjamin F/Sara L
6797 N SR 65
I lazlcton IN 47640
Benjamin F Kixmiller
6797 N SR 65
HAZLETON IN 47640 State Parcel Number Legal Description
26-06-06-300-002.757-017 009-02757-00 PT W SW 61 9 3.37 AC
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
nn
.ig Addicss(r umber and street,city,state,and ZIP code)—' — ---p-Sumc ni propertyaddtur - — -- —-
0 q7 N 1-10-3e-6-•- ) n) 147(4 LID
Spouse First Middle Last
LUvv x a�•�
Mailing Address(Number and street,city,state.and ZIP code) 1 Same as property address
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, •• or she may be liable for back .y and substantial financial penalties.
Owner I Sia •we ice/" Date
•