Homestead_Seifers (2)CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION Hclo
Stela Form 5473 (RT I 54
Prescribed by the Department of Lo®I GavenmaY Fvsnrr+
INSTRUCTIONS: See reverse ride lcr Ming insfiecdons.
. � ... ... � ...' CEItTffICATION STATEMENT. ,. � u '•;. .. �, , .+ ,n: (..
I (We) &Mthfk .1 tWOa day of March. 20_
I (We) occupied as ore principal place of residence rt6vving d real property for which a Homestead
Pmperty Tax Credit is hereby claimed:
l (We) owned ❑ Are bt+Ybg under ccn bvrd
Have a beneficial entered in the entity that is liable for the properly tares an the property and thaEOSSOW09Opypr rrtder a conbacL
: }• •; .. i` CONTRACT.d�CORDEDio-itr_ .r '.': :14i:r.r...`.: ,... u.r. �; < i xE.. <_ 7`I «Xs
Elf Wyvg on � ibact Fee Sin ple ommes name
ftauardefs orece where contract is receded Revd number Page
I . f.(v'. PROPERTY DESCRIPTION,-,,-
Toxrship
Taxiig district (ray
�b- IOD -Ou3 -till oi? I �the p"
tt arry portion of the res+dert I ion uchve or the taro nor.�..e�. z, _.._ (1) acre that i nuKliately surrounds that
dale properly cmimd to pm&c brmrne.
property L_J Mobib Hbhe(fC. 6-1.1 -7)
used m produce income. describe the use and portion
PROP8M OWNED BY CLAIMANT 0i'OTHE3t COUNTIES ,
County
Township
County
Township
I hereby certify the above statements are true, correct and corrglefa.
m of daimarx
'lass (numbs and sties!, dh: sraLa. ZlPoode �S _ v 1 �✓ � d
(
Titt1ETA7C ' A
ASSESSED VALUE H
HOMESTEAD �. i
icNON- RESIDEtfML"k��+'�r,F
'.ASSESSOR USE ONLY,..' .
VALUE[. �
�AT 100X OF TTV V
VALUE 2 i �
� O
.• i
Land not exceeding 1 (one) acre In edialeh/ .
(1)a 5
i r) l rn '3.`.?r°�brf, �� - .'fir }� �K gY'1
sranoundeg residential improvements. (
54 S>'kA£n''%'`�'•, �;%s'����i+
Other land (
(2) .
.' r
r'';•�: +
Tdsi land (Ivm 1 pkm lam 2) (
(3) 5
Dwelling (
(4) s
55 `
Residential krgmvenients or Annually D
6:,.N.�
Assessed Mobile I Marnrfectoved Home 5
5
Other m4mvements (
(6)
Tdal improvements (rare 4 through fine 6) (
(T)
Trial value (fare 3 pks fine 7) (
(S)
1 hereby certify the above is true, correct, and S
Signature of Assessor D
Date signed
Ve hying action - Sigrmaae of Auditor D
Date signed
STANDARD DEDUCTION ALLOWANCE,.
20 _ Pay 2O
Lesser of 12 Homestead
Valuation or SM.000 f
Signature of ate
�0
MATE FIRM A!M,RU PO raASTILfA FORM TS-1A
.APPROVED BY MOTE RIHRD OFMTTRITS-"or PILD RIBED BY FIE DEPARTMENTOF FPC&L DONTINMIAT FTASCE M 6-I.I-E:-11
Gibson County Auditor
101 N Main IMPORTANT NOTICETO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individual and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
mare beneficial.there is more incenthe than eter for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
HEA 13+3-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to incise the
benefit and to preside additional identifying information necessary to allow county government to better monitor homestead
Omen.This information will be kepi 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 oftciali eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Seifers, Scott/Dusty
6963 N SR 65
Hazleton IN 47640
1013
Scott Seifers - - -
6963 N SR 65 State Parcel Number Legal Description
HAZLETON IN 47640
26-06-06-100-003.471-017 009-00117-00 SW NW 61 91.00 AC
NIC
• PART 2:TAXPAYER INFORMATION
OwnerA First Middle Last
®ng Attics(fiumber mid'atETr[,ity,slate,and LAP code) - - - — — - —
Warne xme;u pmpen y addras ---
—
69960 3 'N s2 6 5 #a-ile-4- _ J X74 Li
µ First n / Middle p Last e
C�✓iS St I CYS
Mailing Address Number and street,city,state,and LIP code) Fpfaanhe as property address
&90 3 M e_co S /-/ode-f-av•- T �)(ado r
_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 liabl: or back taxes and substantial financial penalties.
Owner 1 Signature A.01. Date
PART 4:ADDITIONAL INFORMATION
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