Homestead_Deibler STATE FORM 53569(R3/5-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-8.1
IMPORTANT NOTICE TO'IIONIESTEAD PROPERTY OWNERS-`' t
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
muses 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 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 Local
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
PART1: PROPERTY INFORMA I'(ON
Taxpayer Name - Property'Address Slate Parcel Number Letal Description: -
James M/Stacey M Deibler 10848 S 350 E 26-23-02-300-001.870-024 PT W 2 4 10 2.097 AC
HAUBSTADT IN 47639 0.9
•
Complete and return to: - I®IIDu]111Ol®Dll110I9�DflDf®W1hDW W®
. GIBBON COUNTY AUDITOR."101 N MAIN PRINCETON IN 47670 ll Il, 11 Wl Illlll
PART.?:TANPAI'ER INFORMATION •
Owner 1 First Middle Last
•
S+ CE tern - mA2ic bE_L 8LEt,
Mailing Address(number and street,city,state and ZIP code)
!/Same as property address
• IO`3u8 3S0 E \-1A■A6S ►\ OT 7 (p39
•
51....se First Middle Last
aES • r
Mailing Address(norther and street.city.state and ZIP code)
\bSL1S S ISO E o-0\`o -\I� S\ Q i` I Same as property address
p\v\ '-\'163�
.. ;
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 Signature Date
• //
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
state Fortn 5173 (R7 � s-o�
Prear�ed by ihe Departrrienl ot Laal Gwertvriertl Feance
INSTRUCTIONS: See reverse side (or fiiing insbvcfirons.
,,.
FORM
HC10
�
i nve� ! � l I 4 ' 1 C,P certify tliatI oIn the 1 st day of Mamh, 20_
I(VJe) 'ed as our prinapal plaoe of residence the fo desaibed real property for which a Homestead Prvpeit�T� O�t(�Fj'ereby daimed:
�(We) owned ❑ Are buying under wntract
riave a benefidal interest in the entity Ihat is liable for ihe property taxes m Uie pmperty and Nat owns the prvpe�Ay acu bli�g wder a cantracl
tt buYe�9 om m�tracl. Fee Simple awr�efs rartie
Retordefs ot6ce
�b
�o��ry
Rewd numbm � Page
Tunship
r Legal tlescri Is the properly in question:
�0� -3Cb -�01: �D - �.l � -LI lb o � � ❑ M�� �,�,,.�. 6,.,_n
of the rasiAernial struMe w fhe ImLtl ppl n�ceeding ore (1) aae tlu1 unmeGately cu�unOs Umi s�ae is usad to 7�duce iicort�e. desabe the �ae end 7�n
y�n;sma m woduce a�mme. C.l� Y
a.oq��-c.
Tovnship
1 hereby certify the abave sfatements are true, carecl and complete.
end s6ee4 �: �re. LP code)
>u-� ,� 3a x 5 q �J
Land not exceadirg 1(one) aae imnediatety
simound'vg residential improvements.
Other land
Tdal IarW (1'vre 1 pkulme �
DweRng
Residential imptovements aMnually
Assessed Moble / Manufa�red Home
Garage
QM�a unproverr�en�
TUaI vnprovemertts (I'me 4 fhiough 6ne 6�
Ttlal value (line 3 pda Grre n
I hereby certify tlie above is W e, corred, and
COR1pI8tB.
�M�B actlm - Sigimma d AudOOr
County
�t.�b� ..�- �.1
�':'tTRUErTAX:iiv-ye ASSESSm,
:,,`.,fYALUE�:�g� 6.kF'. ,cATi3100'b;0
(�)
(Z)
(3)
(4)
(5)
(6)
(�)
(8)
s�� mn,�
7 ((y �
signed
signed
'.?:v7mi"v,�bA[I��`�1z?b'i,+%�<y����.xvn:..�,�:.rs,vl,T:STANDARD;DEDUCTiON�'ALCOWANCE i.k�.:'�k>�:jtYC.�::.�Ltg��°){d'.sia:=a*a'(.�e'���i'}G,^`,�,�E�.�.i�;
20_Pay20_
Lesser af 12 Homestead
Valuatim or E35,000 E
Signalure ol Ndita Date sipnetl