HomeMy WebLinkAboutHomestead_Blume STATE FORM 53569023/S-10) IYFASLFFR FOtM 1S1A
APPROVED BY STATE BMRO OF ACCOUNTS.2039 PRESCRIBED BY THE DFPARTMEST OF LOCAL 0OVir•MESIT FINAV(£IC 61.13341.1
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 Ulan a er(or homestead fraud.Homestead(mud causes higher tae bills for all;therefore,
2009 requires taxpayers alp receive the homestead standard deduction to Verify that they are eligible to rectum the
go to provide additional identifying information necessary to allow county government to better monitor homestead
I ' information will be kept confidential and can only be accessed by authorized county officials.The Del rtment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
APR 14 21 PART 1: PROPERTY INFORMATION
��� Taxpayer Name Location Address
C. 'K _ ` - Blume, Charles R
GIBSON COUNTY AUDITOR
24 10370 S 150 E
= HAUBSTADT IN 47639
2789
Charles R Blume II I II111 III II1 III 11111 Ill 1110 III II1 dl Bill IIiII I QII0111I. Ill llI liIlliltfi1011 III
10370 S 150 E
HAUBSTADT IN 47639-8028
LSrrirllllritlll"irllii'Iliii"Ili'I'IIIlliillillillrllllililli State Parcel Number Legal Description
26-19-32-101-001.641-024 /£LPERS SUB DIV 8 D-9
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.
�o�/ PART 2: TAXPAYER INFORMATION
ON I �/vIGW`K' First - '/' Middle ��% i ° " –"" Last
Mailing Address(number and street.city.state,and ZIP code) ❑ Same as property address
/03ZD Si i5 DE, Wa4Adt, t 41- ieZ63 y
-—
Spouse - Firstl - Middle Last
Mailing Addles(NUmbit ad stmt,city;state;and ZIP code)`- ` – '9 Same as propcity addressr .
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below) ,
I I I I I I I I I Stint
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. ,
•
e%�� CLAIM FOR HOMESTEAD PROPERTY TAX
li�;: CREDITISTANDARD DEDUCTION
�� S�ate Form 5473 (R2 / 5�92)
��u�
INSTRUCTIONS: See reve�se side 7or Iiling instruc�ions.
�FORM
HC10� f
y�
YEAR
^ , N
i
t�Y' 1 0199�
"' qi il��rno �-. _
I(Vr�� r that on the tst ay of March. 79_
I(We) occupie as o�r princip place of residence ihe fo lowing described real prop riy or � a Homestead PropertyTax Credit is hereby daimed:
�I (We) owned ❑ Are buying under contract �
Have a bene`icial interest fn the entiry that is liable tor the property taxes on the properry and ihat owns the property or is buying under a contract.
CONTRACT RECORDED
If buying on con;ract. Fee Simple owner's name
Recorder's owi�e where contratt is reCOrded Fecortl number Page
COUnry
Pa�n�Q
II any portion ol I�e�
ol Ne propeny utilized to
ITownship
/ r� ` Legal tlescription /
simcNre or the land not exceading one
¢e Income.
PROPERTY DESCRIPTION
Ta.ing tliSlrici (city. fowrt :ownship)
thal immetlia:ely surmuntls that stmcNre is usetl to prOtluce income. tlescribe ihe use and portion
� �/ - / 9 . �.�7 -/a/- �/ / 5 % Qo? 5L � �
ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not e.ceeding 1(one) acre immediately I' � I I
surrounding residential improvemen;s.
Other land (p) (
Total land (line 7 p/us line Z/ (3) I I
Dwelling (a)
Residential improvemenis
Garage ( (5)
Other improvements (6) I
Total improvements Qine 4 �hrough lina b� �7� I I
Total value (line 3 ptrs line 71 (8) I
I hereby certify the above is (rue. Correc�. and I Signawre of Assessor I Da;e sfgned
complete.
Verifying ac�ron - Sgnawre ot Audi;or Da;e sfgnetl
� STANDARD DEDUCTION ALLOWANCE �
I79_Pay19_ I
� Lesser of v2 Homestead
Vaivation or 52.000 S
SignaNre of Autliror Date si ned
�-�p -q 5