Homestead_Breivogel da
.\riNT En 11.1'31-,71.11,11R13 01'krrnI lVl(!I/M P4r`YMIn(DBYiIII mPMTt6`Ir(FL(MLCAWEL4MrtR rPA\CE IC 6-I.1-12A.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N Main '
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 exrr for homestead fraud_homestead fraud causes higher tax bills for all:therefore.
If HE.\ 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to teethe the
• benefit and to provide additional identifying information neem an'to allow county government to better monitor homestead
filings.This information will he kept confidential and ran only be accessed by authorized county officials. he Depanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION .
c.
Taxpayer Name Property Address
Breivogel, James R/Mary T 398 w / &0 S
.--P 0 13o..735
Ilaubstadt IN 47639
10863
James R/Mary T Breivogel
398 W 1200 S - State Parcel Number Lezal Description
Haubstadt IN 47639-8810
1t1n11ur1r11nnllririninlr�nlnnillintlt lrtluitlntll - (- 0-00.0.167-024 004-00167-00 PT SW 741037.03 AC
7 11.0'1' X/ '..o-A40-Q D 9
10
a l-z3 -07-0 oo ooa . 575-6 a<L
1 PART 2: TAXPAYER INFORMATION
Owner I --�� First nn Middle Last
dllMES K AYMOND d7RE I V OGE L
IDAddress(number.and street.city.state,and coded 2'Sarne os properry nddrev - -- - —- -
39g' w /DDS HAugsrAor zed 47499
Spouse First Middle }� Last
Mg
Ai �68E5A .JRE I JDG E L
Mailing Address(Number and street,city,state, ZIP code) 2 Same as property address
398 w /.700S Hqugsrflar IA 47639
={-
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),Signature D
� CIAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fwm 5473 (RB / 4-03)
Prescribed Oy the Departrnem of Local Gwemment Finance
INSTRUCTIONS: See revorse side lor liling insfruclions.
0
FORM
HC10
YEAR
I (We) ''�'° �i
certify ihal on the 1st day of March, 20_
I(We) occupi as our principal place oi residence lhe foll described real property (or ich a Homestead Pr�� T�c Ge���ereby daimed:
N
I(We) o ned ❑ Are buying under contract %J �
iHave a benefidal interest in ihe enGry Nat is liable tor the properry �a�ces on ihe property and that owns�property9�s bGyfpg under�a �tract.
If buying om m�Vact. Fee Simple owners name
Remrdefs office where mnVaq is recarded
CAUnty
Tavnship
fawn, fownship)
Record number � Paga
Parcel n— r /� ��� I Legal description // I Is the property in quesUon:
/Yl // �r'i/
6�/ �L 4i Real Droperty ❑ Alobile Homo (I.C. &f.1-�
Heny portion of Ne residentlal sWCWre w Me land not e:ceeding one (1) acre Net immeEiataty swrounds Iha� re is used b Droduce income, describe d�e uae antl panbn
M the proOeM uGiaed to pro0uce ifrcome.
��
County
Tavnship
I hereby certify the above sfatements are W e, corred and complete.
and abeef, ciry, a�t7fe, LP code)
D� � ff_ ,. !S�
County
_ . .
� ,'-r'�:F"�:�:..a�'.:��,'',MS'f.::.i:�Si�?�`�FiT'c..s°:�"'F<�:�`:•v?�;STANDARU:OE�UCTION " ..ANCE �..�.�. s'+n.��% yn � � .-,s'Yh_ r`� ' ;:t-[�t f.
.,.> >5..., .,,.. /�LLDW } . . �°�a�'ia� .. _ rx`'-#'��3.: •d .
20_Pay20_
Lesser of 1/2 Homestead $
VBUa4m a 535.000
Sqnatureotfwddw. " �atasgneC