Homestead_Griesemer st rt I ORM'3M Or U,114, TREASU LER FORM—IA
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Gibson County Auditor
101 N Main 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
mom beneficial.there is more incentive than nee for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they am eligible to revere the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kepi confidential and can only he accessed by authorised 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 Properly Address
_ Griesemer, Carol A
301 S Stout
aa
Princeton IN 47670
3073 .
Carol A Griesemer
301 S Stout State Parcel Number Legal Description
Princeton IN 47670-2233
11111111111111111111111 lllll ltlrlllllrlllllfltll 11111111 26-12-07-402-002.601-028 019-02601-00 PT SE 7-2-10.20 AC
PART 2:TAXPAYER INFORMATION
Owner I
00-)C---0'e— First W✓1 : .-- Middle Last
- ®@'Address((number and savct,city,state;raid Zl code) e�prepgrty
3 D l /1 Ab-f iOani ,.. (1,,i17670
Spouse First Middle Last
Mailing Address(Number and street,city,state,and"LIP code) n Same as pmpeny address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pax 4 below)
sew
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.
Ow I Signature Date
•
- _ _
,.•^n . , �- -
eE _°, CLAIM FOR HOMESTEAD PROPERTY TAX
���_�ec�+'� CREDIT/STANDARD DEDUCTION �
,��e�..;��� State Fortn 5473 (R2 / 5-92)
.�
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INSTRUCTIONS: See reve�se side lorliling instructions.
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I(We) �__�, e.t. n a. � �� . � certify that on the 7st day of March, 19_
I(We) occupied as our principal place of resitlence the tollowing described real property for which a Homesiead Property Tax Credit is hereby claimed:
�'(We) owned � Are buying under coniract .. , . .
iave a beneficial interest in ihe eniiry that is liable for the property taxes on ihe property and that owns ihe property or is buying under a contract.
� . .. . . �� � . . . .
If brying on contract, Fee Simple owner's name
Retorders ottice where wntract is recorded
IRecord number I Page
PROPERTY DESCRIPTION �
County , � - • . Township � , • Taxi�districi (ciry, rown; fownship) . . , ,
.i� �� �
Parcel �m6er Legal tlescription
01� "' oa.caol- �b "
Ii any portion of the residential strucNre or the land not ezceetling one (7) acre that immetliateiy surtountls that siructure is usetl to produce income, descdbe Ne use and ponion
ot lhe pmperty utilized Io prOduce income.
ASSESSOR USE ONLV TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land noi exceeding 7(one) acre immediately �
surrounding residential improvements. (�) . �
Otherland � (p) .
Total land (line 7 plus line Z� (3)
Dwelling (4)
Residential improvements
Garage (g) �
Other improvements (6) � �
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line 7� (g)
I hereby certify �he above is Uue, torrect, and Signamre ol Assessor Dare signed
complete. "
Verityirg action - Siqnature ot Auditor Date signed
STANDARD
19_Pay79_
Lesser of 7l2 Homestead
Valuation or 52.000
S
SignaWre of Auditor ua�e signeo
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