Homestead_Sollman (12) STATE FORM 53569(R.'B-09) TREASURER FORM IS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS.2C09 PRESCRIBED BY THE DEPARTMENT OF LOCA1.GOVERNMENT FINANCE 1061.1"-8.I
IMPORTANT NOTICE TO HOMESTEAD-PROPERTY OWNERS b •
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 ever for homestead fraud. Homestead fraud
•auses higher tax bills for all; therefore, HEA 1344-2099 requires taxpayers who receive the homestead
standard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
information necessary to allow county government to better monitor homestead filings. This information
will be kept confidential and can only be accessed by authorized county officials. The Department of Local
Government Finance will use this information to create tools that will help county officials eliminate
. homestead fraud.
PART!: PROP• Y INFO'CIA ION
Taxpayer Name Property Address State Parcel Number Leeal Description:
Michael 3 Sollman 1200 S y • 26-23-16-101-002.310-024 004-00440-00 PT NW NW 16410
Haubstadt IN 47639 VVV V 2.4793 AC D-9
Complete and return to: /�
•
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
/ ' 1/CN'Ait 379 &(LM?ttJ
Mailing Address(number and street.city.slate and ZIP code)
rrli'iname as property address
17 49 E (2OO S T f A.1g snore b 9-74.39
Spouse - First. • Middle Last
KA-rH y 3xA30E So LLMf}7✓
Mailing Address(number and street.dry,state and ZIP code) [,"Stae as property address
..
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he cr 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 -s and substantial financial penalties.
Owner I Signature , / Date
(
- PART 4:ADDITIONAL I FORMATION
•
CLAIM FOR HOMESTEAD PROPERTY TAX �� FORM YEAR
� CREDIT/STANDARD DEDUCTION
S1ate Fortn 5473 (R8/7-07) HC10
� � Prescnbed by the Departmem aF Local Govemment Firiance
INSTRUCTIONS: See reverse sitle /or ffling insLUttions.
��e) �— ' / ' aton�@�st�a�o 20—
I(We) occupied as our prindpal place of residence the following des ' real property for which a Homestead PropeAy Tmc Credit is e�r y1 daimed:
� I(We) owned ❑ Are buying under oontract �� ���
J Have a benefidal interest in the entity ihat is liable tor the property taxes on the property and that owns the �q�es�{y or is bS�ing unH§I a contract.
ONCODUrv :,�..._--
It buying om m�vact, Fae Simple o.mefs name
Recadera office where caNaa is
Tamship
Record number � Page
e/��n,�umjba�{�/ q�� /y� MLegal descnplion Is m ueslion; _
�(/ lTJ 1���'l Z�/� V v�� Pr�l VropertY ❑ Mo6ile Home (lC 6-1.7-n
If afry portion of the residerrtial atructure a Ne Wrd nd wcc�rg one (1) acre thal im�ately surtwnds Ihal eVUCWra is used in produce 6wortre. tleuribe Ure use aM porlbn
N tha property uUGZed b pmduce inoome.
•' •
� • . � • �
��'. �
Land not ex�rg i(one) aae immediately ' 4� `�,.2 - �-
surtoundirg residential improvements. ��� �",r�',;>,� . a
Otherlard (2) .� - . . ,
Tclal larni (line 1 plus line 2) �g�
f�K�o;`. � a- .
DwelNng (4) r. ' 1 a , .`e .
Residential improvemenis a Mnually
Assessfld MobBe / Manuf2cWred Home -�.� Y YI. �. � r
Garage �5) ':s5"'T.:•r'='� � -
_ „ �,
Otherimprovements (8) - _�,,"V.`'.;,;i
Tolal improvements (line 4 thiouqh line 6) �7)
Tofal value (line 3 phs Gne n �g�
I hB2by CBNfy the abOVe is We, GOrtBU, eMl Signawre ofAcsessor Dale signed (monfh, day. yea�
complete.
va�p;rp aaon - sprawre or a,awr oa�e sgned (mmW, ear. rearl
2b _ pay 20 _
Lesser of 12
Homestead Valuation
a
45,000 tor 2007 pay 2008 42,000 for 207 0 pay 2011
44.000 for 2008 pay 2009 41.000 for 2011 pay 2012 S
43,000 for 2009 pay 207 0 40,000 payable after 2012
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