Homestead_Ziliak (9) STATE IORM!Mt.tit:1,4.1 TREASURER FOAM 711A
APPROVED BY%TAM BOARD M AnlvvxTS.w• PAM-MED BSIDrDEPARI\ff.YT(FL(x4Lr srtyMrJeT FIANCE IC M.I-L'-SI
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 IndividuaLA and marries couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than on for homestead fraud.homestead fraud causes higher tat bills for all:therefore.
• HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necrsaty to allow county government to better monitor homestead
filings.This information will be Isla conlidenuial 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 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Ziliak, Mark/Rita /'
J/ �'�/QyAe RI Box 117
11 fit�e7res5 v Haubstadt IN 47639 A-,
9593 17 NG 1 /IOOS -- -- —
Mark/Rita Ziliak
1746 W 1300 S State Parcel Number Lezal Description
Haubstadt IN 47639-8664
IIluilu titlinulltitlu luinllutllu tlnitin ltilt t�nFil 26-22-14-400-000.159-024 004-00159-00 PT N SE 14411 .40 AC
X
PART 2:TAXPAYER INFORMATION
Owner I �n First Middle i 7>,ry )` Last
M Ark S��yer/ / i /`
---.Ig Address(number and street.city,state,and ZIP code) — - -'Same as propnty address— - — -—
17 /fo W [3606 rn44s*QO1f y11/ ti74 39
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
•
rt } CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
�/ S�ate Fwm 5473 (R6 / 4-03)
Presnibed �y Ne �epartment of Local Govemment Finance
INSTRUCTIONS: See revcrse side /orliling inslruclions.
FORM
HC10
YEAR
� M'e) / T �ertify t{�iat onE�ie 1st day o( March, 20_
I(VJe) octupied as our principal place of residence the following d ' ed real property for which a Homestead Prpp¢�at C(�O� hereby daimed:
U l� 1 1
❑ I(VJe) owned ❑ Are buying under coniract
�� Have a benefidal interest in the enti that is liable for the ro e taxes on ihe ro e � /� � n
b p p M p p rtY and that owns the property oi is btrying under a hpnVact.
I( byvg on conVaU. Fee Simple owners name
RecoNels atfice where coniracl is recorded
County
Parcel nu�
O
H any portion of Ue resitl
of ihe pmperry uGl¢eG to
Tpvnship
sWCWre w Ne land na
ice income.
Rewrd num�er � Page
Eislrict (city, fown,
�� /��/ � • �'�%%�. � Realproperty ❑ MoEileHOma(I.C.67.7-n
one (7) ace that immediatey wnaunds Ihat s Gure is usetl W protluce income, describe Ihe use antl ponion
�L'`�'-r�F �;�`4�.�"'�°��—�X4!?'iYS�>--'� ,?Sa�.� s.srsc..��-r, .�_°n... �.. .. ..* �.i^�...+,s av
ASSESSOR USE ONLY�� i TRUE TAX � ASSESSED�VALUE �?HOMESTEAD� �'tNONyRESI�ENTIAI }+
3 « y-,����n,y���,,.� ��_,�-,�'�.� ��UE�.�.�� �,AT�100°h OFTTV� �VALUES',�"*Y'. ����%��VALU���'���
Land not exceeding 1(one) aae immediatety y�'�' t�}"',��aT� '�°, ",�%��,�.�. ��-�;y'�
surrounding residen8al improvemenLs. (� � � � ��_ � r '��„��i
ic�.'�`�`��`r :'�,"` _
Otherland (2) ^��
�.s^ �s
Tdal land (line 1 plus line 2) (g�
.Y �V t�t � � 't�
Dwelling (4) ���� � ��*��„�t��
ResidentiellmprovemenLaorMnua�y �;������.� c^
Pssessed Mohile / Manufa�red Hortie Garage (5) ?. �s,` s- 5t �" �" �
`ri.�'Srbi'a`�i�u'- .Ye'� � 3,:7!
° tT y
Other improvements (6) ������,�,;���
�''.�< kSa . ti
TUaI improvements (line 4 fhrough line 6) (7)
TUaI value (line 3 plus line n (g�
I hereby certi(y ihe above is We, coned, and Signamre ot�.ssessor oate signee
complete.
Veriryi�g acGOn - Signature af Puditor Date signed
. •� _ FU-'= �:.��`Y,E' .. •_ • �=�`�' �'STANDARD:OEDUCTION'ALL'OWAlJCE:r.^�'o''�'a'`"x'¢�+�4.`'-z��=•`+w•^� ° "`a- •`,}�:-v`:
_.. �.��;4`� �+�i+ r.e$�``t.�a�is'"a� _ .. _ _ . _ . - �� • T�"`�. �E.�+.���'.
20 _ Pay 20 _
lesser of 1Y2 Homestead
vauanan a f35.000
S
Sg re f Audda Date si r�ed� ��
L/~
�r--. 4 ' _ _ �i'� ���1 � �