HomeMy WebLinkAboutHomestead_Koch ArrRFORM'ft•IR tfwl TREASURER I.T:}IA
AFrROVEn BY[SITE BOAKDft MT R INT t_N'/ PRISOUDED BY T nr UEPARTx4NT OF LOCAL CAWEL"111,7 FINANCE ICtI.I-L'rl
County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N
PRINCETON IN 47670 Individuals and married couples are limited to one homestead.standard deduction.As the receipt of this deduction becomes
ilimore beneficial,there is more incentise than e'er for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
1 HEA 1344--2IX9 requires taxpayers who receive the homestead standard deduction to verily dot they are eligible to recehe the
benefit and to provide additional identifying infomation necessary to allow county goremment to better monitor homestead
tiling..This information will he kept conlidauial and can only he accessed by authorized county officials The Depannrnt of
Local Uovri- Iacnt Finance will use this information to create ants that will help canny officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION -
Taxpayer Name Property Address
Koch, Shirley A/Jacinto Olivaz J
8921 . State 576 C`
Elberfeld IN 47613
8794
Shirley A Koch/Jacinto Olivaz
8921 S Slate Rd 57 State Parcel Number Legal Description
Elberfeld IN 47613-8447
I I I I I III I I I I I I I I I I I III 26-20-28-100-000.614-001 001-00614-00 PT W 28-3-91.13 AC
ru rat t u t .11111t a rat ti trat n I / 0-19
PART 2:TAXPAYER INFORMATION
Owner I First Middle 1 y- Last
II 400 Icn c: A .
tg Address(nuther and street,city,state,and ZIP code) - — - — — Same as property addreE
/ Si 3,R .52 E-16o_mbe ey t W7s i,
Spouse First Middle Last
Mailing Address(Number and street,city.state,and ZIP code) ❑Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
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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.
Ow er I Signature Date
CLAIM FOR
CREDIT/STANDARD HOMESTEAD
DEDUCTION PROPERTY TAX
�•rl. State Form 5473 (R2 15-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10 1 I .
ADD n A NMI
CERTIFICATION STATEMENT
I (We)
Prop tiiy:TezCreBit�is hre2etiyclaimed>
...
IIIImo���,,,,....,������������
e) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property faxes 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
T n district (city, town, township)
Parcel number
Legal description
If any pomon of the residential stmcture or the land 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.
10
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
Signature f imant
ereby certify the above statements are true, correct and complete.
Address (numbe a street, city, state. ZIP code) '
� /I✓ 1/ 3
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements
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
Signature of Assesor
Date signed
complete.
verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
5
Valuation or $2,000
Signature of Auditor I '
Date1lsigned