Homestead_Botzum STATE FORM.53.w IIC I yrl tAFA91tIA FORM 3-IA
ArrrrwED BY•IATL GOURD OFVVU N11.IBN IRMIDE)nT ntr DEPARTMENT if LOCAL GOVERNMFAW ETAVCE IC VI.t-r.-t.l
101 Gibson Main IMPORTANT Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS u
PRINCETON IN 47670 Individuals and married couples are limbed 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 bills for all:therefore.
HEA 1344--2009 requires taxpayers who receive the homestead standard deduction to verity that they am elicible to receive the
•� benefit anti to provide additional identifying information nece.s ry to allow county government to better monitor homestead
filings.This information will be Lea confidential and can only be accessed by authorised county officials.The Department of
local Government Finance will use this information to create tools that will hrip county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Botzum, Edward/Annlee �V
R2 Box 173
Ilaubsmdt IN 47639
10899
Edward/Annlee Botzum
2061 E SR 68 State Parcel Number Legal Description
Haubstadt IN 47639
26-23-09-200-000.155-024 004-00155-00 PT N 9 410 2.97 AC
PART 2: TAXPAYER INFORMATION
Owner I // First Middle Last
gel Wn V-r . .1 Cnf7 r/ m
.v Address(number and street,city,state,and ZIP code) — - - --- -❑ Satre as property adds¢ -— -.-- - — —. — - —
*noil 4o1-
41 1s8 /.w ttW 47443
Spouse First Middle Last
0 - 35
4nn le — Rn7-za 01
Mailing Address(Number and street,city,state.and ZIP code) ❑Same as property address
9.010/ (a JL caPe d 74 e. ui4 4 L24 4174,59
Each undersigned certifies,under penalty of perjury.that the above and foregoing information is true and correct and that he or she is elieible 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
al
1,U111'I �Ufl ftUi=.�ILr�� �_I',UI Clll I uv� t,i�t� i �i� i.�u� .L O �
� _ SEE�1r„ roR FILIP7G lidsTRUCTio(dS ` f
Z,''„ae) CdGu�dC V- """'^�'�' Cb'� cerEify that on ie lst dal c�
�+tzrci�, 19 , Z, (41e) ecci�ied as our pr nc.ioal olzce or residen� tlie .follv�ing descrih�d real !
t�ror.�rty �or ��hicn a llmrns�._ad Pmp°-rty Tax Cra3it is liere��y l�ing claiuixi: �
l, �� � a�..�i .. . � � �. I
_ �Ej,�-p�l-�: - �
� are bli✓incT u:-r3er mntract , �
y .. �� _ �3 _09-.� -�o. /�� �a� �
� have a h=.�eficial interest in the taxoa er
rro�-,rty D�scriotion. in �.� � 1b,:ti^tii �
'i'�cing Dis�rict (City, Tan, 'Ib"nstti.p): �
I�escel tl�il.y:s I or legal de iption s}��m on tax stata�rst: �
C��: nI: r�� 9=�{-io i.ti7�c� �
I= b���,�ino om m��act: O.ar.�s rr3,� (fee sutrole a.•rr.�s)
_ - Coz`_�act r�ord� :n P_°�*_'d_r's 0'rice - PMard ib. Page
I= ��y mr`�io� o� the resicistial s'tn:cture or the land, not e�se�iing on� (1) acre t}iat
irn:=.iiately surrow-r3s that structure is use3.to pmduce inca�, describe t]ie use arr3 rortia� o�
��� prowsty u;ilized to n-cv3ue incorre
>il:�' OT..�'1°_r CJUi1=1°_j 1P. 4i}LLG}] 1i1f11'v1C� �� G`r7I15 OL 15 bvying T2d1. �7LOF7°-�t��:
� 2 o isas
;
� h�� j ces`i"ry �,he a'�w_ s`at�mnt is true, �rre::t and �n�l°t°• ;
i ~� • � � � i
i
"siana�ure Street 1� ess . (it�, zip ' u.E
*Inciividi��l eit�nr a••�s or is ��yv�g ��°-r a Wntract t�ti�t provids he is to pa� tlie
i
�ro�1 �y ;ax�s on tt�_ resideJ�ce, or has a}rs_ficial intrsest �n t}i_ tar.C�Yer. �
i
- r`OR HSSES50R�S U5E OP;LY -
L-�� not e:cc_e�. �n3 1(one) acre in�r�ciiately
sur•-purr3ing resid�ti31 innrov��ts
O t}»r L3nr3
'1'otal Land
P°S1C�.°�'1t111 L'lA'_"OVQR°11t.5
DwelLing
Garage
7bta1
(1)
c2)
(3)
(4)
(5)
(6)
Tru� Cash
Value
Other I,�rovan��s (7) —
1� ' Ir�roveir�nts - Lins (G) plus (i).eauaZs ((1) (B) _
��ra[7'� C°j'`�Lj� �1°_ �..�ti° 1S t.2.1.'.°_� COL7eCii..� cSYC3 CCIR[�let°_.
S,^�ta�ure e: %ssessc=
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lu
IUSesss.i
Valtiation
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Dat�: 10'�0 • �S
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Valuati^: �
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