Homestead_Keeker • • SLATE FOAM 9w q](foul MANIIR EOLM TAIA
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Gibson County Auditor
101 NMain 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
,off more beneficial.there is more incentive than eser for homestead fraud.Ilonlesread fraud causes higher tax bills for all:therefore.
® HEA 1584-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This inlnmaton will he kept confidential and ran only he accessed by authorized county officials.The Depannent of
Local Government Finance will use this information to create tools that will h:ip county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Keeker, Chad/Samautha
5611 1:250 S
_ _ Francisco IN 47649
4820 _ _ _ — _
Chad Keeker
5611 E 250 S State Parcel Number Legal Description
FRANCISCO IN 47649-9067
26-13-30-100-000.512-004 002-00512-00 PT NW 30-2-91.60 AC
X D-10
- _ - — - -
& /
Spouse First Middle Last
vo m at\-rnq Let KtCler2r
Mailing Address(Number and street,city,state,and ZIP code) 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.
•
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
principal place of residence the follovAng described real property for which a Homeste7moperly Tim edi i hereby qamacdt.
Y
r I I (We) owned El 'Are buying under contract GIBSON COW T
(WI)
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying W
nod u" U.
KTRACT-,REC0RDEDV-!Vffff-9-
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY. DESCRIPTION
County
Township
Taxing rict (city, to", township)
I ArnlaA
Parcel n bar
AA
at description Is the property in question:
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0� —
- V-F—j Real property 0 Mobile Home (I.C. 6-1.1-n
If my portion of the residential structure or the kind not exceeding one (1) acre that immediatety surrounds that structure is used to produce income, describe the use and portion
of the property utilized 0 produce income. I 0
Land not exceeding I (one) acre immediately
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0,'ASSESSQWUSFONLY.--� 9,0M-47-1
County
Tow ship,
County Township
I hereby certify the above statements are true, correct and complete. Q
Sig Lure of clkmant
VAL e-j
Wits (number and street, city, state, ZIP code)
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-TRUE�T AMX
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ASSESSED,%
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h' "N I Eg�M,'-
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VAL e-j
Signature of Auditor
Date signed
Land not exceeding I (one) acre immediately
surrounding residential Improvements-
2 FI
Other land
(2)
L?= 4t
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
0
W
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (fine 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
TM - 41�W00VISTANDAM. D EDucmm'
R AL110WANCE
:1 POW-6 % -
20 _ Pay 20 _
Lesser of 1r2 Homestead
F
Vathation or 835.000
Signature of Auditor
Date signed