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Homestead_Kamman (3) STATE FORM 53569(R3/5-10) TR:ASLRER FCR.M TS-IA APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF IACAI.GOVERNMENT FINANCE IC61.1-22-8.1 • IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS 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 "pauses 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. • PART': PROPER V INFORMA ION- . Tarpaver Name Propeets Address State Parcel Number Legal Description: Jeffrey D Kamman/Donna G Hipp 12684 S 200 E 26-23-16-400-000.759-024 PT NW SE 16 4 10 2.48 AC HAUBSTADT IN 47639 D-9 Complete and return to: I1111IIDtln111MMEmf71m 11 ILtnt®01lI H©mf11171® GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 Llflu IWaJ II flllll PART 2:TAXPAYER INFORMATION Owner 1 First Middle Last --Jcir .. r \I p4NiEt— . V n1n74 hi Mailing Address(number and street city.state and ZIP code) I`,I sane as propcny address 17a 3y s ao D 6 , t/A h Bs7.gD— 1N /76 7y�/, ' First Middle--- Last D 0NNA 64 i • - " I'? q/'1mAN Mailing Address(number and street dry.state and ZIP code) Same 05 property address l.2 8L1 5 )oDE 1/Acies—AD LW 47&3 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 Lt _ c- PART 4:ADDITIONAL IJNFORMATIOfN . FILEt // • DEC 1 9 2012 // v \ GIBSON COUNTY AUDITOR �f=T��r� - _ .. a.�/'�" °, CLAIM FOR HOMESTEAD PROPERTY TAX � �': CREDIT/STANDARD DEDUCTION .�,f � Slate Porm 5473 (R2 / 5-92) �� : INSTRUCTIONS: See �everse side tor filing instructions. CERTIFICATION �� J I ' I,�I ��. a�� ',i. � i , : . .i e) � _ _ certify that on Ihe lstp�jj ��� �_ II cu as ou principa�e of residence the toli wing�described real property for whic a omestead Property Tax Credit is hereby claimed: I(We) owned ❑ Are buying under contraci . � Have a beneficial inrerest in the eniiry thai is liable for the property taxes on ihe property and thai owns ihe property or is buying under a coniraci. .. . . . , . CONTRACTRECORDED . - � It Wying on contracL Fee Simple owner's name � - -. � Recortler's oHice where contract is recortletl Record number Page Couniy Parcel number Le I �� o�I �b"� 5�+� O C� �ny portion ot the residential simcNre or ihe land ot the property utilized to produce income. PROPERTY DESCRIPTION . � ` Taxing dis[riCt �dry. town, lOwnShip) �. - -�l� �C I�-`�-I � Z_�(g�� one (1) acre that immediately surrounds that struc[ure is used to produce ifxome, descri6e the use arW portion . . . . . ..' ' ' . ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL VALUE VALUE VALUE VALUE � land not exceeding 7(one) acre immediately . surrounding residential improvemenis. (�) Otherland (p) Total land (line 1 plus line Z� (3) Owelling (4) Residential improvements Garage (5) Other improvemenis (6) Total improvements (line 4 through line � (7) Total value (line 3 p�s line 7) (g) I hereby certify �he above is lrue, correCi. and Signamre of Assessor Dare si9ned complete. —�fying aaion - Signamre ot Auditor Date signed n STANDARD DEDUCTION ALLOWANCE ( 79_Pay19_ Lesser of 7/2 Homestead Valuation or S2,000 S SignaWre of Auditor Date signed �