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Homestead_Koch STATE FORM 53'M in-tot TREASURER rOPN:SIT
NPRrWEn BY%VAL BOARD OF MY ANT,.9r PITY 1BW BY TTtr OFPARfl (T{W LOCAL Ovt.BNVrAn IN\CCE K 1.1_4.1
Gibson 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 ta'bills for all:therefore.
HEA 1341-2009 requires laxpasen,who remise the homestead standard deduction to sexily that they are eligible to remise the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.'Ibis information will be krysi confidential and can only lc aceecsed by authorized county officials. Depanment of
Local Government Finance 'till use this information to create tools that will help county officials eliminate honeslead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Koch, Raymond Leo/Mary Ann
R I Box 369-;::711-
69 I501
-._- . _
laubstadt IN 47639
9510 _
Raymond Leo/Mary Ann Koch •
11429 S 150 W State Parcel Number Legal Description
HaubstadlIN 47639-8751
II�IIIIIIII III 1111_1_1_11IIIIII111_1_1_1111_11_1_1 III II III 26-22-11-400-001.596-0 24 004-01596-00 PT SE 1141110.00 AC
PART 2: TAXPAYF.RIINFORNIATI N
Owner I First Middle Last
Qa-yrnon4 Leo Koc-t.
g Address(number and street,city,state,and ZIP code) ✓ Same as property address -
Spouse First Middle Last
Mar y n n Alice Pow
Mailing Addr (Number and street,city,state,and ZIP code) • j -Same as property 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 I Signet (� Date
aE �'� g CLAIM FOR HOMESTEAD PROPERTY TAX
;��: CREDITISTANDARD DEDUCTION
.�.,;� State Form Sa73 (R2 / 5-92) .
�si.
INSTRUCTIONS: See reverse side lor liling ins(ructions.
I �We)
I (We)
� � � � � ��-
JUN 1 01996
MENT
c certifv that on~e 1�tld���arch, 79
upied as our principal pla��f residence the following �scribed real pmp�r�y for which a Homestead Property Tax Credit is hereby claimed:
�� U
owned ❑ Are bGying under comract :
a beneticial imerest in the entity that is liable for the pmperty taxes on the property and ihat owns the property or is buying under a contract.
- - - CONTRACT RECORDED '
It buying on contraa, Fee Simple avner's name - � �
Recortler's oflice where tontract is reCOrded Record number Page
PROPERTY DESCRIPTION
County � Township . Tauing dis�ric� (ciry, to n, fo shi �
Parcel number legal de5tr io
_ (�
If any ponion of the resitlential SWCNre or Ne land not ez eedin ne (7) aae ihat immediately wrwunds that structure is used to produce �rmme, tlescri6e Ne use and portion
of the property utitizetl to produce inmme.
G�� - �.3 //- 00 - 00� �� - 4�fL
PROPERTY OWNED BV CLAIMANT IN OTHER COUNTIES
Counry TownShip Counry Township
I heretyy�certify the above statemeqts are true, correct and complete. I Sio�namre of daimam
srreet, aty. stafe.
wc
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately
surmundinq residential improvements. (� � �
Otherland (2)
Total land (line 1 plus line 2� (3) .
Dwelling (4) .
Residential improvements
Gara9e (5)
Other improvemenis (6) .
Total improvemen�s (line 4 th�ough lina � (7)
Total value Qine 3 pbs line 7) (g)
I hereby ceRify the above i5 We, oorreCl, and Synature of Assessor Dare signed
complete.
Verirying attion - Signature of Audi;or Date signed
DEDUCTIONALIOWANCE
79_Pay19_
Lesser ot 1/2 Homestead
Valuation or 52.000 S
— I Date signed : ;;