Homestead_Doerner (2) SIAM FORM!3!ts1 l r'AM, rNF.NNIri FORM 79-1A
IMPORTANT NOTICE TO PXFSOLIBED BY T111 OWNERS
Gibson County Auditor •
101.N Main
PRINCETON IN 47670 IndividuaLs and married couples arc limited to one homestead standard deduction.As the receipt of this deduction becomes
6 more beneficial,there is more incentive than net for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-3009 requires taxpayers who receive the homestead standard deduction to verity that they are eliride to recehe the
benefit and to provide additional identrtstne information necessary to allow county government to better monitor homestead
filing:.This information will be Lepr confidential and can only be accessed by authorized county officials.The Dkpartnent of
Local Government Finance will we this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Doerner, Matthew S
—. _. - - - - _ - _ ---- -- '-- -- - - --- K2 BOX 23t----'r. - -
Ii1.HERFELD IN 47613 ,y 'T/
3259 I
Matthew S Doerner ^ 66
9874E 700 S State Parcel Number Legal Description l
OAKLAND CITY IN 47660-7724
�r�r t��rrr�rilrtr��r r��rrr�rtr��rrr�t r�t�r�r r��rrr�r�rr�r��rr� 26-20-14-100-001.882-001 001-01882-00 PT SE NW 14394.49 AC
-- -- - X
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 INFORMATION
Owner-I- - - — - - .. First Middle ,^ ^ f Last
.ng Address and sweet,city,state,and ZIP code) Lille ti ' 'O�me 1-
Spouse First • Middle Last
12)LO — °)-- eun k-. • C LLUV?uLj -
Mailim,Address(Number and street,city,state.and ZIP code) (ame as property 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.
Owner 1 lg." 1)erc
i 4/6/70
/
7-N. PART 4:ADDITIONAL INFORMATION •
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (RS 14-03)
Presrnbed by the Deparone t of Laced Governmen Finance
INSTRUC77ONS: See reverse lido Ibr l8i p ivburbory.
FORM YEAR
HC10
F 1
I (we) 142 -4 /w-4- I—) t" % ( /40S4CQ 0jaA .) certify tha qo the 154 of March. 20
(We) occupied as our principal place of residence the following described real property for which a Homestead Propfert�j5Y& CCrredifjs 17rreeby claimed:
(We) owned ❑ Are buying under contract GIBSON COUNTY AUD R
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.
4� k vr��-� �� n V;Tyr`CONTRACTRECORDED's�')"t s` 'z�itr = svr» ,�a:a 2- L"'•i; r.'�y:d. :'f:s: k� >
If buying on contract, Fee Simple ownees name
Recorder's office where contract is recorded Record number Page
s� x.,,_ - ;,�:��pr_�PROP.ERTY, OWNED! BY�CLAIM/ 1NT ;IN,OTHER(:OUNTIES,Ir",es�'�. ,e.'ssgio'�z �r,�� . r �•,- ':'.�T'ti�3"•.T
7lif: �pL.`.-,-° 3x+=' <_- `•��..:r�.�1�t'`� "�,'w"`JH,'
County
Tuvnship
Toxin is city, to wnship)
P cat number p'
—O �O
scription
Is the pmpe in question_
�eal
V
N(q
property ❑ Mobile Home (I.C. 6- 1. 1 -7)
If any portion of the residential structure or the land not ex mg one (11 acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income. C71[1
ll
/
4o -I 'S`= r,0- D/. (Y907 -6O
s� x.,,_ - ;,�:��pr_�PROP.ERTY, OWNED! BY�CLAIM/ 1NT ;IN,OTHER(:OUNTIES,Ir",es�'�. ,e.'ssgio'�z �r,�� . r �•,- ':'.�T'ti�3"•.T
County
Township
County nship
hereby certify the above statements are true, correct and complete.
S191kature of claimant
$
/
Address (number and street, city, state, ZIP code)
�''s -fit 3'�'F"A S SSOR SEO LY
i STRUE TAX
ASSESSED VALUE
-.HOMESTEAD
""' NONiE510ENT1AL �'
VAU_lE�4y,
ATa100 ° /,_ -0F D
Land not exceeding 1 (one) acre immediately
13 + ,Yt-` °'e�kf; ✓?
surrounding residential improvements.
Other land
(2)
.a
Total land (line 1 plus line 2)
(3)
'Residential
Dwelling
(4)
4F?,a�¢°`��.
-""zw
Improvements or Annually
AW,F°1_'°
Aagessed Mobile / Manufactured Home
Garage
(5)
Y
_,Y�a����,�. 4
Other improvements
(6)
iWIMW - ?{
Trial improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD: DEDUCTIONiALLOWANCE'- `z';•.ai;,4,.yy ,1,„1;,7'"X':'= T._`t+'�Su".,=
20 _ Pay 20 _ "
Lesser of 1r2 Homestead
Valuation or 535.000
$
Signal a
Date signed