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Homestead_Siekman (7)y Rx� CLAIM FOR HOMESTEAD PROPERTY TAX i CREDIT /STANDARD DEDUCTION State Form 5473 (R2! 5.92) sysvv� �77s1 INSTRUCTIONS: See reverse side for tiling instructions. F1 YEAR YEAR 1 •HC10`- NOV 03 1998 '- .-CERTIFICATION STATEMENT : v " I (We) .� �fY��) U 1 \ L� Cu t I 61Ylify that on the 1 st day of March, 19 10^`te) occupied as our principal place of r sidence the following described property for which a Homestead Property Tax Credit is hereby claimed: 1 (We) owned ❑ Are buying under contract ❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract. - _ _ • - CONTRACT RECORDED It buying on contract, Fee Simple owner's name Recorder's office where contract is recorded Record number Page . - - - PROPERTY DESCRIPTION County Township Taxing district (city, town, township) Parcel number l -616 - Legal description It any portion of the residential structure or the lard 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. ASSESSOR USE ONLY TRUETAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL VALUE Land not exceeding 1 (one) acre immediately surrounding residential improvements. (1) Valuation or $2,000 " Other land (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 plus line 7) (g) 1 hereby certify the above is true, correct, and complete. Signature of Assessor Date signed Verifying action - Signature of Auditor 1 Date signed (r STANDARD DEDUCTION ALLOWANCE" " 19 Pay 19 _ Lesser of 112 Homestead Valuation or $2,000 Signature of Auditor Date sig-etl SLATE FORM 5NN IRI fwl MIASMA FORM 3IA Al./lath MPORTANT NOTICE TO HOMESTEAD PROPERTY RONNERS zrl n ' Gibson County Auditor r 101 N Main e 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 ever for homestead fraud Homestead fraud causes higher tax tills for all:therefore. HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the benefit and to provide additional identifying information necessary to allow county government to better monitor homestead filings.this inforn ation will be kept confidential and can only be accessed by authorized county officials.The Department of Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud. PART 1: PROPERTY INFORMATION Taxpayer Name Property Address C Siekman, James W/Michele A to O 1 S. S.SO G R2 B.,.,2f I - Buckskin IN 47647 2 James W Siekman 8670 S 850 E State Parcel Number Legal Description Buckskin IN 47647-9002 1t1rt11ttt1r 11rrr1tri1rrr 11r1rr11rrr11 11111111111111111 26-20-27-10`0-0/01.673-001 BUCKSKIN 17/18 /` 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 James /Wmes f it( Cl/xl Jl-e kni Al•-) ng Address(number and street,city,state,and ZIP code) © Same as property address d(0. -w s. 9-s0s-- AL, c%St;ru, r,.) 4-04I(ov) Spouse First Middle Last PI n Mailing Address(Number and street,city,state,and ZIP code) ©-Same as property address -(J 7 D S. Ursu 6- 31.c G,es k I. rJ 2/v 1/7‘y 7 PART 3:CERTIFICATION -- Each•undcrsigned certifies:under penalty ofperyury,.that.the-ahoveandS oreuoing.informatinn.is.true.and correct and that,hegr,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 7