HomeMy WebLinkAboutHomestead_SeifersCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR 1.
CREDIT /STANDARD DEDUCTION A HC10
a State Form 5473 (R2 15-92)
INSTRUCTIONS: See reverse side for filing instructions. ,
MAY 1 G Pnni
dkk r\ CERTIFICATION STATEMENT
I (We) '�- - pie, ottythhat on the 1st-day of March, 19_
I (We) oc ied as our principal place of reside a the following described real property for which a Ho �IiAA ®tpp{Ir�dit is hereby claimed:
❑ I (We owned ❑ 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 property or is buying under a contract.
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded -
Record number
Page
PROPERTY DESCRIPTION .
County
Township -
Taxing district (c/% town, township)
P c I number
Legal description
a �'
If any portion of the residential structure or the lard 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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
�reby certify the above statements are true, correct and complete.
Signature o aimant
Address (number and street, city, state. ZIP code)
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
-
Otherland
(2)
Total land (line I 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 plus line 7)
(8)
I hereby certify the above is true, correct, and
complete.
Signature of Assesor
Date signed
verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
®
19_ Pay 19 _
Lesser of 1/2 Homestead
Valuation or $2,000
$
Signature of Auditor
I \)
Date signed
sutS FORM 5314n1ti Ivo.. TRH SUPSRWm4StA
.APPROVED BY STATE BUstO OF AEYrALNIS.20,N PPFrBIBtD BY THE DEPARTMEYTOF LOCAL CAVCR.4MFA'r F NANCE IC 4-1.1-2:4.1
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 Imams
more beneficial,there is more incenme 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 are eligible to recene the
benefit alai to provide additional identifying information necessary to allow county eovemment to better monitor homestead
filin..This information will he kept confidential and can only be accessed by authorized roomy officials.The Depannlent of
Local Goverment Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Seifers, James C Ff/57 4) 5
7
r_ Patoka IN 47666 0I
195
James C Seifers •
4137 N SR 65 State Parcel Number Legal Description
PATOKA IN 47666
26-05-22-100-000.967-017 009-00967-00 PT LOC 2 FR 22-1-10 1.63
AC D-12 C-1
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- -
PART 2:TAXPAYER 1NFOR)1ATION
Owner I First Middle Last
LIQMCS C Sc, [ RS
Ong Address(number and street,city,state,and ZIP code) ® Same as property address
q/3 kJ, SR A-5 PA #Orq r,). Li 7666
First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Diva's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
sea
• 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
•
PART 4:ADDITIONAL INFORMATION