Homestead_Siekman (3)FORM HC 10 1979
Prescribed By State Board of Tax Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 7 9 ✓
SEE BACK FOR FILING INSTRUCTIONS Q 0�� Q 0 pl( , 0'0
*(We) ' ' -4 - ) f�TM ( J -V ' - certify that on the 1st day of
arch, 19-2Y_ I, (We) occupied as our principal place of reside the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) gowned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description i
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name (fee simple owner)
,���� Township
or legal description
shown
on tax
statement:
LrJ "y
3 /-
3 -
Contract recorded in Recorders Office - Record
If any portion of the residential structure 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
Any other counties in which individual owns or is buying real property: County Township
hereby certify the above statement is true, correct and complete.
/) n
Street Address
Cn, Slate and Zip
Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
True Cash
Value
Land not exceeding 1 ) re I medi y
surrounding residential rolemedts (1) � o
Other Land ®® l (2)
Total Land 1IN ' 31979_ (3)
Residential Improvements Dwelling (4) °? 0 y
arage (s) CL
r/I , a G
AUDITOR Total (6)
Other Improvements (7) - —
T Improvements - Line (6) plus (7) equals (8) (8)
I . y certify the above true. correct. and complete.
,gnat a of Assessor
ACTION BY AUDITOR -
Approved: • 7
Assessed Homestead
Valuation Valuation
Date:
•
SLATE FORM 13M.CC1!-NI tPFASltER FORM TSIA
APPROVED Dv 5IAIL WARM Of AVVFAINIS.!nrn PAF[RTflt RV ME DEPMTY6rr OF LOCAL DOVER-NWT,FINANCE IC 6-I.I-_-!.I
Gibson County Auditor
r 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and tarried couples are limited to one homestead standard deduction.As the receipt of this deducion becomes
more beneficial.there is more incentive than eser for homestead fntni Homestead fraud causes higher tax bills for all:therefore.
IV o HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filinte.This information will he kept cants ential and on only he accessed by authorised county officials.The Department of
Local Government Finance w ill use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
. Taxpayer Name Property Address
Siekman, Don/Bonnie Jo
_ Oakland City IN 47660
9288 _ _
Don/ Bonnie Jo Siekman
11584E 1000 S State Parcel Number Legal Description
Oakland City IN 47660-7811
IrlttlltIIIIIItrtlittiItttltttllttlttttlltttlllttlltlttllttirl 26-21-31-100-000.946-001 0 1 946-00 SW NW 31-3-869.80 AC
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
to N A 5� 76,72,9)
•,g Address(number raid street,city,state,and ZIP code) - - — -- — gSame as property address --- — - — —
((52 V is /oo-e S. 0,9 i xi C)4- ��- V11,10
Spouse First Middle Last
rE 0Nr.(. ii S. &Frkrlad
Mailing Address(Number and Fl street,city,state,and ZIP code) Same as property address
11.54#or /!)005. �nEl,,aie q?bbo
• .
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