Homestead_Siekman (6)e 4 CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
Slate Form 5473 (R215 -92)'
.me
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC70
1/We) � - _ \%f iY J certify that on the 1st day of March, 19
��cupied as our prin ' plat of residence the fo lot ing described real property for which a Homestead Property Tax Credit is hereby claimed:
h(We) owned ❑ Are buying under contract �j'� "� y{�
❑ Have a beneficial interest in the entity that is liable for the properly taxes on the property anti that owns the proper dr�bingr
Bract
CONTRACT RECORDED APR 1994-
If buying on contract, Fee Simple owner's name - -
Recorder's office where contract is recorded Recoid nurl� DITOp a e
PROPERTY DESCRIPT -
County
Township Taxing dis ict tit I town, townsh,) ,
umb r
Legal description
15
(1)
It any portion of the residential structure or the land not exceeding one (1) acre that immediatety surrounds 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 �+
L�reby certify the above statements are true, correct and complete. 1- ature of daima t
` Address ( umber nd street, ory, state. Pcode)
a - W
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Otherfand
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
-
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pbs line 7)
(g)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
v- rifying action - Signature of Auditor
I Date signed
19 _Pay 19_
Lesser of 112 Homestead
Valuation or $2,000
STANDARD
Signature of Auditor .,I � (\ \ x \ ( \' \ � � I vote sgngo I �_
a STATE FORM.Ma 1R_e,-v1 lREASI R FORM TS-IA
APPROVED BY MU BOARD Of ACCOUs1c-`VM PRISCRIDED av MEOFr,WP1EMr OF LOCAL rovetNMrwt FINANCE Ie.-1.1-r4.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
• - PRINCETON IN 47670 Individuals and married couples are limited to one homestead siandanJ deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than eter 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 am eligible to receive the
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 he accessed by authorized county officials.The Depanmem of
Local Government Finance will use this information to create cols that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Siekman, Gregory W/Amy K
Buckskin IN 47647
8801
Gregory W/Amy K Siekman
8463E 900 S State Parcel Number Legal Description
Buckskin IN 47647-9001
1 ,I ll -- Ill_ea i,- - Il - 26-20-28-200-000.053 001' 01 5300 PT SENE2&39.59 AC
' — ��i�u� ut�t��nt�nll tit �t ttn t It - t
PART 2:TAXPAYER INFORMATION
Owner I r First Middle Last
n Address(nu and vet t,city,state,and Z code) • „fame as property address
CICD5 L�.KSM
use First Middle Last
P,M,� l Aew � in
S . K �
Mailing Address(Numbe and street,city,state.and ZIP c e) to as property address
-
/ PART 3:CERTIFICATION
Ea.111Wfflarlrlinirtifies,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
PART 4:ADDITIONAL INFORMATION