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Homestead_Kiesel (18) STATE FORM 53569(8315-10) TREASURER FORM TS-IA APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1"-8.I IMPORTANT.NOTICE TOJIOiMESTEAD•PROPERTY.OWNERS o • Individuals and married couples are limited to one homestead standard deduction. As the receipt of this ., 'Suction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud auses 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. -. - - -FORMA- . PAR 1: PROPER Y :-FOR ION - Taspave-Name Property Address State Parcel Number Leal Description: 1 \ .) 3238 W SR 68 '� Edward R/Kelly A Kiesel 26-22-03-100-001.578-024 PT W 3 4 11 7.16 AC D-2,.., HAUBSTADT IN 47639 Complete and return to: I®IIff11fL1lllfflnpnm® IIIHIMh]©I IDIDPflnl® • GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 'I. 11 WI lllLl PART 2:TAXPAYER IN FORMATION . - - Owner I First Middle last 1=t1 an.rA cat R . Kie5t' I Mailing Address(number and street.oily,sand ZIP r ade) I 'app as property address 3138 Lk) 5R Lo Fin u -rs tan_LU _.LA1 47(.03 9 Spouse First - . Middle' Last Y,el1 A . h•�e5c I Mating Address(number and street.city,state and ZIP code) I Same as property address 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 PART 4: FILED. NOV 282012 c. .m y GIBSON COUNTY AUDITOR e%-^_�3 - E q CLAIM FOR HOMESTEAD PROPERTY TAX �; x�� CREDIT/STANDARD DEDUCTION .�:;,�� S1ate Form 5a73 (R2 / 5-92) iu� � INSTRUCTIONS: See reve�se side Ior 7iling instructions. iL ��� CRD AR APR 7 1993 M T AUDId�,�n the 1st day of March. 79_ � occu i as our principal place of resMence tae jblloWmg described real pmperty for which a Homestead Pmperty Tax Credii is hereby daimed: 1/ (We) owned ❑ Are buying under conddd lave a beneficial interest in the eniity thai is liable for the property taxes on the property and that owns the property or is buying under a contract. CONTRACT RECORDED - � If buying on contract, Fee Simple owner's name_ � , Recorder's oHice where contract is recorded Record number Pa9e ' � � PROPERTY DESCRIPTION County � Township . Sa�cing disirict (city. town,.ro r Parcel npmbe _� A_O � Legal descriPtion � _ ^ / . l 0 � It any ponion oi ihe residential s�rucwre or Ne lantl not exceeding one (1) aue ihat immediatety surrounds that s[rucNre ot ihe propeny utilized to produce income. Coun,y -U� yuu-cx�/.��a-UasT PROPERTY OWNED BY C�AIMANT IN OTHER COUNTIES T �h�� Counry certify the above statements are true, correct and complete. Sig�na�2ju e ot Uaimam . `�P Q �.c�14r ;number aM streeC ciry, stafe, ZIP code) . - v. v d ro protluce irim e, deusibe Ne use and portion ASSESSOR USE ONLY � TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL . .VALUE VALUE VALUE VALUE . Land not exceeding t(one) acre immediately surrounding residential improvements. (�� � ' Otherland (p) Total land (line 7 plus line 2� (3) Dwelling (4) . - Residential improvements _ Garage (5� � • ` ' Other improvements (6) Total improvements (line 4 through line � (7) � Total value (line 3 pbs line 7) (g) I hereby certity the above is Irue, CorreCt, and Signature of Assessor Date signetl complete. ying action - SignaNre of Auditor Da;e signed 19_Pay19_ Lesser of 7/2 Homesiead Valuation or 52,000 � S natureo�Autluo vam r g �c � � � �