Homestead_Kiesel (16) STATE FORM 53569(82/3.9) TREASURER FORM TS-IAI
APPROV ED IT;STATE BOARD OF.ACCOUNTS.2009 - PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-t.122-ti
IMPO ' X1lNO 1w --`1!O NOM' AS -AD ' RO ' 0' YOW'NI :i...
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
fuses higher tax bills for all; therefore, HEA 1344-2099 requires taxpayers who receive the homestead
s andard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
0
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.
U 1;iljfls kAnnailariy IN 0 RM yto 9 •
Taxpayer Name Property Address State Parcel Number Legal Description:
Kevin/Rita Kiesel RI Box 95 26-22-03-300-000.745-024/ 004-00745-00 PT E W 3 4 I 1 2.61 AC
Haubstadt IN 47639 ✓ Q2
Complete and return to: •
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
BART 2: TAXPAYjER L\F,ORMATION -
Owner 1 First Middle Last
/726/67n If j .4" /
Madmg Address(raanber and street,aty,state and ZIP code)
Same as properly address
• 3003 wsE&e
'
(
. / - / /' '/ - - ._
sr__.e First Middle Last
Madag Address(number and street,city,state and ZIP code) Same as property address
3/0.3 west6 f{ s—1 C1 S—
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 1 Signature Date
PPART S$ADDITIONAL INFORM AMR
i
• .
a%-'r" g CLAIM FOR HOMESTEAD PROPERTY TAX �� FORM YEAR
�a�� CREDIT/STANDARD DEDUCTION ���� HCto � �
„�p .;�� State Form 5a73 (R2 / 5-92�
�si� fl p 9
INSTRUCTIONS: See ieverse side tor filing instructions. MP R d 0 �99�
�p�Q AUDITO � �
I(We) �y.v.J �(- ertify that on ihe 7st day of March, 19
�'e) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
� I(We) owned ❑ Are buying under contract
' Have a beneficial interesi in the entity ihat is liable for the property taxes on the property and that owns ihe property or is buying under a contract.
CONTRACT�RECORDED � -.
It buying on contracL Fee Simple owner's name .
Recorder's ottice where coniract is recortled Record number Page
County
PROPERTY DESCRIPTION
�i di;trict (ciry fagn, fownship)
Parcel number Leqal tl�s fiptio
so'��00��00 �I.� � � -'�-I� a.f�l��
If any portion of the resitlenlial structure or the Wnd not exceeding one (7 � aae �hat immediatey surrounds that swtture is used to protluce income. tlescribe the use and ponion
ot the property utilizetl m produce income.
�%�al�i � ♦ / � / �i`��/f'i�
PROPERTY OWNED BY CLAIMANT IN OTHEP COUNTIES
County Township County
�—
reby certify the above statements are irue, correct and complete. Signamre of ciaimam ^
�l .
(number and slreeC dry. sfate, Z/P cotle)
ASSESSOR USE ONLY TRUE TAX "'ASSESSED HOMESTEAD NON-RESIDENTIAL
� .VAWE _ .VALUE. VALUE VALUE
Land not exceeding 1(one) acre immediately
surrounding resideniial improvemenis. (�) �
Other land (p)
Total land (line 7 plus line Z� (3�
Dwelling (4)
Resideniial improvements .
Garage (5)
Other improvements (6) _
� Total improvemenis (line 4 through line � (7�
Total value (line 3 p�s line � (g)
I hereby CeRify lhe above is Irue, correct, and Signawre of Assessor Date si9ned
complete.
ing action - Signature of Audimr Date signed
19_Pay19_
Lesser of 1/2 Homestead
Valuation or 52,000 S
Sgnature
ALLOWANCE