Homestead_Seibert (10) S TATE FORM!!!aIR'I..-061 TPFASURFR FORM ZIA
•PPROVED BYRSrL MARI)Of AnTµs'Ic.yry PREYNDFL BY TIDE DEPARTMENT OFIs%tx, VEIONItcc Fa:ASCE IC 64.1,224.1
Gibson County Auditor 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individual>and married coupes are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than eser for homestead fraud.Homestead fraud causes higher tax bills for all;therefore.
0 HEA 1344-2109 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to remise the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings This information will he kept confidential and can only Iv accented by authorized county officials.The Ikpannsenl 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
_ Seibert, Kevin R/Jennifer A
RI
Ilaubstadt IN 47639
7201
Kevin R Seibert
2384 W 1000 S State Parcel Number Legal Description
HAUBSTADT IN 47639-8610
— ----- --- —26-18-35-100-002:107-024— 004-02107-00SUNSET-ACRES-2-
111111611III1111I11I11o11111111 III 11(1111LJllIlloll X
PART 2:TAXPAI'F.R INFORMATION
Owner 1 First Middle Last
hey'n P. �,) r
alpAddress(numbs and street,city,state,and ZIP code) :, Same as property address
Spouse First Middle Last
Snrii r so ,
Mailing Address(Number and street,city,state,and-LIP code) )1 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 Signature Date
• v
, CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
� S�a�e Fortn 5473 (R611-03)
Prescnbed by the Department o1 Local GovemmeM Finance
INSTRUCTIONS: See �everse side (orlling insfmclions.
YVI � FORM
HC10
—� � _ '��� ��
YEAR
i Nve� / U[A/ Uti 1 �,�3 ,� ceniry wai on en�� �Fday of N/ar� zo_
I(We) pi as our principal place o sidence Ihe owing described real property (or which a Homestead Property Tac Credlt ish���///€1777�6y'daimed:
I(VJe) owned ❑ Are buying under wnlract � � / L n
�
Have a benefidal interesl in the entiry Nat is liable for the property taxes on the pmperty and �hat owns the pmperty.w.isbuying.under'a�conUaU. '
/.. �,�p�r�.�r;'.!I...iTVA�•'_-^'. �
116uying on conVact. Fee Simple owneYS name
Remrders ofice where conVaC is recorded
County
Counry
Record number � Page
ramsnip
er L Idescri Gon' Isthe m �m �uestion:
� O� O��O P � O �*cea�D�opeM ❑ NwbileHwnoQ.C.6/J-�
of the residential sW aure or the nd not exceeding one (1 � aae Ihat immeEiatety wrrounds ihat swuure is used b protluca inmme. desaibe Na use and portbn
y utilizetl W produce irrcome.
c�G -/�-3s-/�- �a�. /D% �� j�
�`��,ObO if�-I4 �n�r � nP_x,-�.Q
Toxnship
I hereby certify lhe above statements are W e, correct and complete.
wm�ber ^and streef, dry, afafe,
� \� � �� �
Land not exceeding 1(one) acre immediately
surrounding residentlal improvements.
Other land
Tdal land (line 1 plus line 2)
Dweliing
Residential improvements or Mnualty
Assessed Modle / ManuFaQUred Home Garage
Other impravements
Total improvements (line 4 through line 6)
Tttal value (line 3 plus line n
I hereby certi(y ihe above is We, corred, and
complete.
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lz)
(3)
(4)
(5)
(6)
1�)
IB)
Signature otASSeuor
signe0
signed
�.t::r' - 3„y -sw ,r = <� � s�STANDARD:UEDUCTION'ALI:OWANCE��d'�`'''';,r.�S+t�i� -5u-�'+F`��.�'¢�-.^� �^s!Sr� Yi.aeh
'£�a" -.._:.,r'�e�'�..�T.r,et7M '-�"� _ .. A� _. _ . ._ ,.�`�..�r`�..yf . . . si�Z±�3!� r.�.'t:
20_Pay20_
Lesser ot t/2 Homestead
vawanon w S35.OW
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SignaluraofAUditw ' DatesigneA