Homestead_Kroeger STATE FORM 53509(Rl/&10) TREASURER FORM TS-IA
'• APPROVED BY STATE BOA RD OF ACCONTS.209 ` RESLTIB19 BY TIE DEPARTMENT OF LOCAL GOVERNMENT FMAVCC IC 61.1-22AI
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
• L benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
1 L filings.This information will be kept confidential 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.
JUL 6 2011 PART 1: PROPERTY INFORMATION
• a
Taxpayer Name Location Address
a- a C. . y- - Kroeger, Stephe Doroth
GIBBON COUNTY UDITOR 8749 S SR 57
pP ELBERFELD IN 47613
h52 0
8968 Ezc7B lr_ZcOco'
Stephen, .broth Krueger I IIIIIIIIi11111 1 110 III011 11III 11 IIII_I[I 111 III
8749SSR57
Elberfeld IN 47613
State Parcel Number Legal Description
26-20-28-100-000.431-001 /PT NW 28-3-9.72 AC 0-19
•
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.
PA Rili.:SA_PAIES/NFO� IaTIO\—^-------------------
• ., -r 1 First - . Middle Last
art 414 e-ti VR ore C.E
Mailing Address(number and street,city.state,and ZIP code) 6\Same as property address
8? to 5: SC E7 1N . Lk 76I
Last
Mailing Address(Number and street,city,state,and ZIP code) a 0 Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
2 I I I .. - l 1 1 1 .I 5r.
a 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. a
Owner I Signature Date
-•
)
PART 4: ADDITIONAL INFORMATION
FORM HC 10 7919
Prescribed By Slate Board of lax Commissioners
to Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 7 �'
Do / -.O o '3/ —oo
SEE BACK FOR FILING INSTRUCTIONS
IfWe) V certify that on the 1st day of
.arch, 19 `2, I, me)occupili6d as our principal place of r idence the following described real property for
which a Homestead Property Tax Credit is h--errqee/by being claimed:
I, (We) El owned a6-�� -a� -/4:�To- 6G0.141-Qol
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in County Township
Taxing District (6ity, Fewer, Township):
Parcel Number or legal description shown on tax statement:
If buying on contract: Owners name nee simple nwnen
Contract recorded in Recorders Office - Record No
If any 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
Any other counties in which individual owns or is buying real property: County Township
1 1 hereby certify the above statement is true, correct and complete.
Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
FOR ASSESSOR'S USE ONLY -
True Cash Assessed Homestead
Value Valuation Valuation
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other Land
Total Land
Residential ImprovemeF I
Dwelling
4-
jui 1979
Garage
Total
Improvements Q ����
,Qiher
Improvements - Line1(6) plus (AP%TPFs (8)
Si ky certify the above is true. correct, and
complete.
Assessor
\ x.
(1) & o
(2)
(3) ,3 l00
(4) / 7
(5)
(6) / 7 I O
(7) _
(8) /0
ACTION BY AUDITOR_:
is o
s =iy- 19
date
Date: A A7