Homestead_Agee a
MAIL FIRM!!.w R 1.-tnl IAr:3SUUR FORM CIA
VIMw'En BY STATE NRRO OF mltMa.yx ILEAIWm BY THE DEPARTNE47 OF LOCAL CamR:NEAT FINANCE IV H.t-r I 4
Cibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
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 tat bills 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 pnwide additional identifying information necessary to allow county government to better monitor homestead
flings.This information will he Let confidential and can only be accessed by authorized county officials.The Depanment 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
_ Agee, Michael J/Eva L •
tlaubstadt IN 47639
8375
Michael J Agee
3426E 1025 S State Parcel Number Legal Description
HAUBSTADT IN 47639-7876
26-19-34-400-002.085-024 004-02085-00 PT SE 343101.00 AC
(t1u��n t�t��nnlitlil n�n ��u� n � �u n rlin'11111
J D-10
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
midnaP,1 :_nY\e� lea _ -
•ng Address(number and sweet,city,state,and ZIP code) — -— -p-6Srne so�operry oddrev — - -- -- -
Spouse First Middle Last
EV0. 1_k3nIrN �C.
Mailing Address(Number and street,city,stale,and ZIP code) 139me• puny 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 tare Date
•
; CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� Slate Fortn 5673 (R6 / 4-03)
Presfiibed by lhe �epariment of Local Govemment Finance
INSTRUCTIONS: See revcrse side !or liling insfmctions
I(VJe) .. v. w 1/certiy o� Ihe`'ISt day of March, 20
I(We�'occupied as our principal piace o sidence the followin described real ro e � ^��^� ^-�= i!- ��r�^-� �•^-�� —
g p p rty which a Homestead Pmperty.Tac.Credit is_hereby daimed:
I e owned ~ ���
(W ) ❑ Are buying under conGact
Have a benefidal interest in the entity that is liable for ihe property taxes on the property and tliat owns lhe property or is buying under a conUact.
�
� FORM YEAR
��_ I HC10� � �
, 1 '� n � Ij
�`.� ��� ,�� '
lhat
I( buying om m�trad, Fee Simple owners narne
Recordels atfice where contraq is remrdeE
"+�S'#��"��;=a.r.3�`�s�'..�:i:n.r.v�s....ks5..^`3�
K �u>:.S-
County Tamship
Tating tlistrjE�l(ciry, toqn, (ownship)
Record number � Page
Par�ce5l number C Legal scription �` �'6 (� �1ihe properry in fion:
V� ��' G �n��1- � �� ) C �7 � � �CJ RealDroPerty ❑ MobileHOmo�IC bf f-�)
H any poNOn of ihe revdential sW ctura w Me Wnd not esceeding one (1) acre ihat immetliatey wnounds Ihat shuGUre is usad b Droduce income, tlescribe the use anC portion
of Ihe properry ulilized tn produce income. /
'QC
County
-/)/�o�. /)��
To.vnship
I hereby certiy the above statements are We, correct and wmplete.
(nom6eraM s�met, city, sfate, ZlPcode)
Township
�"'� 'z<'Rcy�--Y.�'�`3t�`•��`? �"�,�,r14 Y't '-^`e � i- .,e,+� . _ . s � e.v.� . ..
„'��'ASSESSOR_IJSE ON' Y.6y�-�-��},�...'>-��'�' i�TRUETAXi .3et� ASSESSED VAEUE HOMESTEAD .1- NON4RESIDENTIALy h
,�5,�gy��_ >�'�n��F.�,�--�x,� .t� ;�yYALUE�"� � ;AT,100%OFIT/ �VALUE�� �� VALUE-��''.sx�r�.�
.-n..u.... aY �s.-.,�..�r...�:..�.
Land not exceeding 1(one) acre immediately �y�"" i""�.y,nis ^��, '�Gt^ n
suvoundingresidentlalimprovemenLS. ��) ,'.��'���� � ,���� �_;;
4. J
N
Other land . �2� +�+:,'�.�a?=-iy" �
?:��.t'v.`.-��
Tdal land (line 1 plus line 2) (3)
��•�.` `�, ��' ;���i
oWen��y (4) �, � �
Residential improvements or Mnuaily '�=`��'�� ��r� �'•'�'"'��
Assessed Mobile! ManufacNred Hortre Garage (5) `����`�;� � v�����
s.'*�,��"�rr�-.'�.7:u..... :'�..+.. %+ti yi
'--` i'+.'i-�*c�: x
Offier improvements (6) :���'" !�
'�a�
:.v�" -v�.. _
Tdal improvements (line 4 through line 6) (��
7olal value (line 3 phs line n (g�
I hereby certi(y fhe above is We, corred, and Signamre ofPSSessor Date sgned
complele.
Verifyi�y anion - Signature oflwditor Date sgned
20_Pay20_
Lesser M 1l2 Homestead
va�enoo a sas.000
3
Sgnature of Auddw " � Date sgned