Homestead_NiemanCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
` State Form 5473 (R8 17-07)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (We) certify that on ti@ dly 9f �9f��, 20_
I (VYe) oocu as our prindpal place of residence the folbwin g described real property for which a Homestead Property Tax Credit is hereby daimed:
(We) Jned ❑ 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 pro a bu
rtv or ano.�eAtIp"act.
CONTRACT RECORDED
7M.79 on contrail- Fee Simple owners name
Recorders office where contrail is recorded Record number Page
ASS �- USE ONLY
TRUE TAX VALUE
PROPERTY OWNED BY
County Tavnship
PROPERTY DESCRIPTION.
County
Tomship Taxing distn (city, town, townshlg1
Parcel number
Lacal descnplion Is the property in ques & :
�,je\• I property ❑ Mobile Home (IC 6.1.1 -7)
If any portion of the residential structure or the [and not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property u[fOzed to produce income.
aio -o5- 57 -o -7 4- 003-RL 0 "17
ASS �- USE ONLY
TRUE TAX VALUE
PROPERTY OWNED BY
County Tavnship
County Township
I hereby certify, the above statementts9s are true, correct and complete.
Sla-t7urre / ai M ��—
/
s(number/ street, afy' ILS�
ASS �- USE ONLY
TRUE TAX VALUE
.
HOMESTEAD.]
• r
$
or 43,000 for 2009 pay 2010 40,000 payable after 2012
AT 100% OF TTV .1
VALUE 1's
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile / Manufactured Home
Garage
(5)
Other improvements
(6)
4:
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
sgrature ofAssessor
Date signed (month, day, year)
complete.
Verifying action - Signature of Auditor
Date signed (month. day, year)
W. STANDARD s s
Pay 20 — 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 1/2 44,000 for 2008
Homestead Valuation pay 2009 41,000 for 2011 pay 2012
$
or 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor
Date signed (month, day. year)
STATE FORM 53569(R35-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-8.I
° IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS '
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
uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
s .r dard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
i
information necessary to allow county government to better monitor homestead filings. This information
will be kept confidential and can only be accessed by authorized county officials. The Department'of Local
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
-PARTI: PROPERTY ,'FORMA ION
Taapa.er Name Prancer.'Address State Parcel Number Leal Description:
John Nieman 265) E STEELMAN RD • 2605-57-074-003.240-017 PT MD 74 1-10 4.01 AC
PATOKA IN 47666
Complete and return to: 1E110 ED I 1110101111101111[1111E0 a OIf71�IfRml111®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 llllll LLO WI
• PART 2:TANPAYERINFORMATION •
Owner I First Middle Last
John Erl'c Ni6punr<
Mailing Address(hunter and street.city,state and ZIP code) Same as property address ,__
02(S ) E SteeLmet,_ Ri Pak L =N t4 --7 6 6(0 . .
Middle _.
-
.b CAA.L.) a1 v `f 7 4 -Y .0 10 • •AIM-G..vi L-..
—
Mailing Address(number and street,city,state and ZIP code)
m Same as prppeTj address
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.
Own 1 Signature Date /
.: :PART 4:ADDITIONAL INFORMATION .. ,�
. 2
• 2
UEC1920 /
12
Vp1T
GIBSON COus(/ UR