Homestead_Kiesel (17) ct&tE FORM!!!W tam/s.nt W LsStttIA TORN 7S-1A
.ArPM■ED BY SIAM BOARD OF.Nrr.NT.s.N PREYNBm BY TIM DEPARTMENT OF LOCAL raw2R.YMEw'r FRANCE IC 41.I21-l1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS:
101 N Main
PRINCETON IN 47670 Individuals and married couples are limited to one homestead sandard deduction.As the receipt of this deduction becomes
�` more beneficial.there is more incentive than ewer for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
® HEA 1344-Mfg requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive a the
benefit and to provide additional identifying information necessary to allow counts'go.emment to better monitor homestead
filings.Ibis information will he kept confidential and can only be aceeoed 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 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Kiesel, Leslie J/M Colleen
— 10685 8 310 W
_. _ -__. _ _ _ _ ._- - — ilauhsmdrIN 47630 —°`_ —_
9446
Leslie J/M Colleen Kiesel
10685 S 310 W State Parcel Number Legal Description
HaubstadtIN 47639-8637
ltl 26-22-03-100-001.828-024 0-01828-OO PTWW 341111.56 AC
tt��ttr�t��tttt��r�t�rt�t t�rr��r rrr��F�r rr��Fr�rr�r�rr�Fr��
PART 2: TAXPAYER INFORMATION
Owner I i
/q� First Middle Last
�tg Address(number and street,city,state,and ZIP code)
Saas > ny addtcv -- - -
o68s S Flo .. /t/ 4 -26??
Spouse First Middle Last
t
a-r CC" (le en L f es e 1
Mailing Address(Num rr and street,city,state,and ZIP code) Same as pro ivy address
\G(? S- S 3 l0 w { u.1 .d.)- iii/ 11)639
Each undersigned certifies,under penalty of perjury,that the above and foregoing infonnation 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
a` � CREDIT/STANDARD DEDUCTION
Slate Form 5473 (R2 / 5-92)
.� ,�� +
INSTRUCTIONS: See reverse side lor liling instrudians.
FORM YEAR
HC10
'� 1����:
I,�We) �'��✓`��-C. `-�l w ��� ���✓^��/�— �'� certity th i on the 7 st day oYMarch. 19_
�e) occupied as our principal place of idence the foilowing described real property tor which a Homestead �ropeyy Tax�Credit is hereby claimed:
,� I(We) owned ❑ Are buying under contract � �IPRn� , �,,..., _
❑ Have a beneficial interest in the entiry that is liable for the property tazes on the property and that owns the property or is buying under a contract.
.. . - - . . .. CONTRACT RECORDED .r • .g::a; -
If Wyirg om m�tratt. Fee Simple owner's name
Recordefs oHice where contrect is recorded Record number Page
Township
Paic�I.�u� r �/�� „ � Legal det
( J � lXl
If any PO(LOn o� IhE r25id2ntidl S�Nttute or the Wnd noi
of Ne property utilized to protluce income.
PROPERTY DESCRIWT30N. '
7a<in9
�t l.� � �—� // `3. �.3qC
one (1) acre that immediatety wrtounds Ihat swcture is usetl ro produce income, describe the use arW portion
. ��� ASSESSOR USE ONLY � TflUE TAX� , ASSESSEO HOMESTEAD � NON-RESIDENTIAL°�,'
- - VALUE VALUE VALUE � . VALUE �� �
Land not exceeding 1(one) acre immediately _ � �
surmunding residential improvements. (�� � . _ �
F
Oiherland . (2) � �'� � -
Total Iand (line i plus line Z� (3) �
Dwelling (4) . ' � ,.
Residential improvements . . . - .
Garage (5) - ° -
Other improvements (6) � �
Total improvemenis (line 4 through line � (7)
Total value (line 3 p�s line � (g)
I hereby certity the above is true. correci. and Signature ot Assessor Date siqned
complete.
`�=ntyirg aIXion - Signa�ure of Autli�or Date signed
79_Pay79_
Lesser of 1/2 Homesiead
Valuation or 52.000
o,
S
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—/0-99
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