Homestead_Gieselman°" CLAIM FOR HOMESTEAD PROPERTY TAX
- � CREDIT/STANDARD DEDUCTION
' State Fortn 5473 (R8 / 7-07)
•� ,��. ` Prescribed by Iha DeparlmeM af Laal Government Finance
lNS7RUCTIONS: See ieverse srde /or filing inshvcfions.
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OCT 1 5 Z008
�iWe) ��("dt ( � s l/%i/�//' certiry�e�li�eCA���f��Q�
I(We) occupied as our prindpal place o( residence the following described real property for which a Homeslead Property Tac Credit is hereby daimed:
�i(We) owned ❑ Are buying under antract
Have a benefidal interest in Ihe entity that is liable for the property taxes on the property and fhat owns Ihe property or is buying under a contrad.
If bvying on contract, Fea Simpe oanefs name
Recaders af4ca where wnirad is recorded
Parcel number
Tdenship
Legal
Is Ue
Record number � Page
Cd- 'lG�/ —�.J��i —( J UJ. 7���Real PropertY ❑ Mobile Home ((C 67.7-7I
If any poAion of the residenGal strucWre or the land not ezceeding orre (1) acra ihal immediately surrounds that ure is used lo produce incoma, describe ihe use aM ponion
of Ihe pmperty W Gzatl In pioduce inwme. a'f �
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Land not exceeding 7(orre) aoe immediately .` '`' � � _
surrounding residential improvements. �� � � � � � . . _
Other land (2� � �
Tdal land (line 1 plus Irne 2) �g)
Dwellirg (q) --
ResidentialimprovementswMnually _ y,.';
Assessed Mobile / Manufactured Home �: i� �
Garege �5) . �',,` .
Other improvements (6)
T�ai improvements (line 4 lhrough line 6) �7�
Tc1ai value (Irne 3 phs line n (g�
1 F�ereby certify the above is We, corred, and Signature ofAssessw Date signetl (month, day. yea�
complete.
Veifyirg adion - SignaWre otAuditor pate signed (monfh, day. yea�
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�—�Y 2� — 45.000 for 2007 pay 2008 42.000 for 207 0 pay 2011
Lesser W 12 qq.ppp for 2008 pay 2009 41.000 for 20N pay 2012
Homestead Valuation S
« 43,000 for 20D9 pay 2010 40,000 payable after 2012
SignaWra ot Auditw Dale signed (month, day, yea�
Gibson CounTy Auditor
101 N Main
PRINCETON IN 47670
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SIiTEl00.\I �).W IR / �+MI
PIIf�YNPFllOT
' iRL�S11AfR F10.4.ti1A
hWividuaL. anJ ma:riN coupin are limited io onc hnm<urad uandaN A.I:Au.iiai. ds ihe retttip� ol thG Jcdceiion bccome�
merc beneficial, thve is morc i�rcenme tlun r�er for home>rcad RauJ. Ilome>ttad fiauJ causes hi�hrr tas �ills for all: thrrefore.
HEA 13Ai-zwn «y�;,�, m.w.��, �no �m„� me hanesce+J siandud JeJuction ui .erily tlut �hcy are eliciMe m rec.i�c ihc
brnefil anl to proeide aJJitiUnal identiiyinc fnitxmmwn necrsvre ta allw� counry gmrmment to bever muniwr Ipmesrc:W
filin��. This inlormalion will be Aery conlidemial and rdn nnly Fe acrezaed M1r awMrived roumr olT¢iuk.'I'hr Ikry�anmem nf
I.ocal GovrmmeN PivMC will u.e this fn9ormatiun m vream twls tha� miil hdn munn• nrT "al< dimidve Is�n�aead fn�d
1837
Rick A Gieselman
1089 S 250 W
PRINCETON IN 47670-8171
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Ta�parer Namr
Gieseiman, Rick A
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Propertc Address
i �R 1 Bot�286 �
Princcion IN 47670
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State Percel Number Leeal Descrintion
26-11-14-300-000.484-027 006-004e4-oo PT SW 14 2 17 3.682 AC
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Owner 1 First Middle � Lazt
� i C_.LE11 �ie5�-1 Mc� '
_ — ic i�tiArcss (num'cer and svee[, ciry, sra[e. anuZlP codej` . -- — — — ' —_ ' _ .' _.f-1 anr�c u� p�openy mldros' _ - ' ! .
Lid'°"" i
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Sceiai $ecuri�y Numbcr (las� 5 die�LS) Driver's Littnse/Sute ID Nmnbcr (lut 5 diviLS) Othcr (pleue specify in Part 4 6elow') �
Middle I l.ac�
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M1failinc Address (Number end svee4 ci�y, stale, and ZIP coJe) � Sume as pmpeny addrea� �
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Social SecuriM1� Number Qast 5 dieia) Drivers LicensdState ID Number (las� 5 digit5) Other (please specify in Pan 4 Mlow) �
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._._ _ Each undersitmed certifies, under penalry of perjury, that the abo��e and furegoing infortnation is we and comect and that he or she is elieible to
receive the homesiead standard deduction on this properiy-Eactrundersitned also-understands that, by,claiming additional homeslead deductions
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unlaufully, he or she may be liable for back taxes and substantial financial penalties. �
Owner 1$ignawre Uatc ,\b Tdcphonc
Spou>e Si�amm pa[e P l �
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