Homestead_Schmitt (6)�' yG YEA`it
CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDMSTANDARD DEDUCTION Hcto
State Form 5473 (R715.06)
Prescribed by the DepaMiant of Local Gove nerd Finance
INSTRUCTIONS: See reverse side for Ming instructions. LJPL--j . / - CERT1FICAMON SYATEYENT I �/ nEff �
I (We) I \--K,() (Z& - W—L- JYYA I T1 r yf U�U "� 44A Wt oe tlb Efle8y of March, 20_
I (We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
0 I (We) owned ❑ Are buying under contract ',`/'�!�
Have a beneficial interest m the entity that is liable for the property taxes on the property and that di� Dr is toying under a contract
CONTRACT RECORDED...
ff burying on contract, Fee sintple owners mm
Recorders office where cmtrad is recorded Record numbs Page
' ` : PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
. .. PROPERTY DESCRIPTION -
Township
County
Tovralip
IT-119 district (ay town,
rrypx
"�'••� /�\
L
is the property in Question:
{' y�f q
Other land
_
ql Real property ❑ Nodk Fbme (LC. fi-1. 1-7)
If any portion of the residential structure or the land not exceeding one (1) acre that mmed rtely surrounds Val structure m used to produce income. describe the use and portion
of the property utifimd to produce u,mna.
(Aa�,c�P � act- ao.a9- iuo- QOO.a�9 -��
' ` : PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
county
Township
County
Township
I hereby certify the above statements are true, correct and complete.
SiWatum of daimart
unbar and sl7t oly, stile, 7111 code)
_�uTp 5. so r, I���r kSki'n
, I N 1�lDy 1
' ASSESSOR USE ONLY � t ,.
- a ; ;
_ `. TRUE TAX,
VALUE,
ASSESSED VALUE
AT, 100% OF TTV
HOMESTEAD'
VALUE .VALUE
• ' NONRESIDENTIAL
Land not exceeding 1 (one) acre innmediab*
surrounding residential improvements.
_
Other land
(2)
Total land (lime 1 pAus Ona 2)
(3)
Residential improvements or Anrwalfyng
Assessed Mobile I Manufactured Home
Dwagi
(4)-
Game
(5)
.. ...
Other impmverments
(6)
.
Total "vrprovements (One 4 through fine 6)
(7)
Trial value (line 3 phs One 7)
(6)
I hereby certify the above is true, correct, and
comptete.
signature of asassor
Data signed
Veifying ac ion - Signet" of Auditor
pate signed
20_Pay 20_
Lesser of 12 Homestead
Valuation or 535,000
f
�W -0 V
SLATE rant s IM_c-_I fRFASnlLA FORM TS-IA
aPEIMPORTANT NOTICE TO HOMESTEAD PROPERTY P OPERTY OWNERS `�
Gibson County Auditor
101 N Main
PRINCETON IN 47670 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 e'er 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 arc eligible to recehe the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This inthrmation will he kept confidential and can only he accessed by authorized county officials.The Depannient of
Local Government finance will use this information to create twls that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Siekman, Gary W/Gwendlyn J
8677 S 850 F
Huckskin IN 47647
3294
Gary W/Gwea: n J Siekman
do KS _a mitt
867 : 850 E State Parcel Number Legal Description
ckskin IN 47647
26-20-27-100-000.279-001 001-00279-00 BUCKSKIN 13
D-19
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 Last
Y2vn ChQC., SChr\k
g Address(number and street.city,state,and ZIP code) Riame as property address
11 -1 5 . 650
Spouse First Middle Last
Lk so, , Pc nr\ Schmk�-
Mailing Address(Number and street,city,stale,and ZIP code) R'Sanle as property address
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
•
0
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