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STATE FORM 53569 OU/LIB) TREASURER FOAM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS SW PRESCRIBED BY THE DEPARTMEVT OF LOCAL COVER%MEYW FLNANCE IC'-1.1-224.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial,there is more incentive than ever 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 are eligible to receive the
-0 P 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
8011011V AIN11O0 NOS919.oca1 Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Location Address•. uoz ady Hemmer, Stephen D
8652 E 900 S
• ���Y ,T II II II II I II ELBERFELD IN 47613
45
Stephen D Hemmer je ►r'o1 liiiIIll_�111110lluulll�ll II III�I�IIJ II0 II.II_IIII III�I.I III�III�II�II_III II III
8652E 900 S
ELBERFELD IN 47613-8426
(Illllltttlli'I'i'I'll111'dill'II1I111ttllllllll"IIIIIIIII11111 State Parcel Number Legal Description
26-20-27-100-001.936-001 i PT NW 27-3-9 2.375 AC
V
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2:TAXPAYER INFORMATION
OM...r I First Z^//Cle Middle � Last
Mailing Address(number and street,city,state,and ZIP code) gr Same as property address
9dts'o2. E 96'D Cr £ teCirze 1✓ //X ( S
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) ❑Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
1 I I I I I I I I sate
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.
Owner I Si % Date
PART 4: ADDITIONAL INFORMATION
IN
CLAIM FOR HOMESTEAD PROPERTY TAX ✓ YEAR
CREDIT /STANDARD DEDUCTION H o
State Form 5973 (11817 -07)
.•r '� Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions. MAY a2 7 2008 aa
I (We) CERTIFICATION certify thatSt on the I day one �f
I (We) occupied as our principal place of residence the following described real property for which a Homestead4j W �wiYis Itet
I (We) awned ❑ Are buying under contract
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 under a contract.
CONTRACT ••r .
If buying on contract, Fee Simple owners creme
Recorders office where contract is recorded Record number Page
STANDARD DEDUCTION
TRUETAXVALUE
20 _ pay 20— 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
11
County
PROPERTY DESCRIPTION.
County
Township
Tax istnct (city, town, township)
Parcel number
Legal description
, 3'7 ,s
Is the property in question:
W
% ' „3 - /}
I ❑ Real property ❑ Mobile Home (IC 6 -1.1 -7)
o arty portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce Income, describe the use and portion
of the property utilized to produce income.
a� -ao- a7 - /oo- oo`
93 6, -00/
STANDARD DEDUCTION
TRUETAXVALUE
20 _ pay 20— 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
11
County
PRbPERTY OWNED :
Township
County
Township
I hereby certify the above statements are true, correct and complete. Signatu cl
state, and ZIP
STANDARD DEDUCTION
TRUETAXVALUE
20 _ pay 20— 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
11
t
$
a 43,000 for 2009 pay 2010 40,000 payable after 2012
WE
AT 100% OF TTV
Signature of Auditor
Date signed (month. day. year)
Land not exceecling 1 (one) acre immediately
-.. .. .
surrounding residential improvements.
(1)
Other land
(2)
Trial land (line 1 plus line 2)
(3)
Residential improvements or Annually
Dwelling
(4)
-
Assessed Mobile I Manufactured Home
Garage
(5)
rr-
Other improvements
(6)
..-
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus Gne 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed (month, day, year)
complete.
Verifying action - Signature of Auditor
Date signed (month, day. year)
STANDARD DEDUCTION
20 _ pay 20— 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 12 44,000 for 2008
Homestead Valuation pay 2009 41,000 for 2011 pay 2012
$
a 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor
Date signed (month. day. year)