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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD If SUPPLEMENTAL DEDUCTION
State Form 5473 (R1216 -09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
APR 2 6 2010
zi CERTIFICATION STATEMENT
I (We) - certify that (vere� oec�w�prt ur) principal
ias�mLy
�I
place of residence or am (are) buying the following described real property for which a Homestead Property Tax @ $U ARitSF GRrned
under contract on the date this application is filed, (date of filing):
Q51 I (We) own ❑ Am (are) buying under recorded contract
Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
INFORMATION
Name of iman(legat name
Social Security number
Social Security number of claimant's spouse (last five digits)
Drivels license I Identification I Other number Issuing State
of ctamant's spouse (last five digits)
CONTRACT ••. .
It buying on contract, Fee Simple owners name -
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
Coun
qx
Township T ' di "a (Crly ! n, towns "p)
f0 d�
Parcel number
L "ption 1
Is Me roperty in question:
,nr
V �' �' s+
Real property ❑ Annually assessed mobile home (IC 61.1 -7)
If any portion of the residential structure or the land not exceeding cure (1) acre that immediately sunoun s 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 COUNTIES
County Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature o claimant
Address (number and street, city, state, and ZIP code
SE ie fl
Land not exceeding 1 (one) acre immediately ;;,L
surrounding residential improvements. O .�-<,• .r :...:;
Other lantl
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
g
(4)
Residential improvementsor Annually
Garage
5
e
Assessed Mobile I Manufactured Home
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Data signed (month, day, year)
and complete.
Verifying action - Signabue of Auditor
Data signed (month, day, year)
( STANDARD DEDUCTION
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any otherpro lion, the sum of the deductions provided in IC 61.1 -12 to a mobile home that is
S
not assessed as real property or to a manufactured home that is not assessed as mat property may not exceed
' -
one -hall (12) of Me assessed value of the mobile home or manufactured home.
Signature of Auditor
Data signed (month, day, year)
STATE FORM 51508 001/MO) - TREASURE FORM TS-IA
APPROVED BY SISTE 110.10 Or ACCOUNTS,2C09 PRESCRIBED BY THE OEYARTMESa OF LOCAL GOVERNMENT HNAYT£IC 61.1.22h1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
, Princeton, IN 47670 more beneficial,there is more incentive than ever for homestead(mud.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 receive the
FILED benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will be kept confidential and can only be accessed by authorized county officials.The Depamnent of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
OCT 132011
Taxpayer Name Location Address
Siekman, Von A
v rv\ 950S
• GIBSON COUNTY AUDITOR OAKLAND CITY IN 47660
2240 II Ip 1
Von A Siekman I II�I�III_�IlIOil III �IIII_I�I IIII .IDII_II��II�IILIII�II�IIII�I I011II��II�II_III�I IIII
11585E 950 S
Oakland City IN 47660-7812
IIII'IIII'111111'Illll'I'I'I'Illllllll"I'llllllllltllll'lllll"I State Parcel Number Legal Description
26-21-31-100-001.658-001 PT NW NW 31 365.165 AC
•
This form MUST b a 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
•
O. I First Middle Last
Mailing Address(number and street,city,state,and ZIP code) 0 Same as property address
014-y 4 //SBSE itSCS 4476 o
Spouse First Middle Last
Mailing Address-64 umber and street,city,state,and ZIP code) fi7-Same as property address
l i c S S `d41+
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