Homestead_Schmidt STATE FORM 53569(123/5-10) TREASURER FORM 7S-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-t 1 22-9.1
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
sta diauses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
dard 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.
PARTI: PROPERTI' INFORMATION' .
Taaoarer Name Property'Address State Parcel Number Legal Description: '
Adam J Schmidt 329 E HIRSCH WOODS LN 26-23-07-204-000.486-024 HIRSCH LAKE ESTATES 2
HAUBSTADT IN 47639 0.9
Complete and return to: I®hi[1i]III DDUmImll1m0I IN B01a®flfl�D�W®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 1 tl
. PART 2: TAXPAYER INFORM - _
Omer I First Middle Last
Aaa-Vit TO 11 n /bit-
Maifing ailing Address(number and street,city,state and ZIP code)
x,I same as property address
may]/ Lap
KS/• Yl l rot. t_v r c 1 r T�1 „.., d 1--
Stang Address(number and street.city,state and ZIP code) / 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 liableArtfaatrises and substantial financial penalties.
Berner 1 signature i Date
. .-
a- FILE
k
• UEL 27 tilt
CIBSO"!Cnl tMTY AUDITOR
CLAIM FOR HOAAESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
sam wm, ssre Rt� i sas� �
PreanbeA by tlie Dapartrrient ol Lool Gorermed Friance
INSTRUCTIONS: See reverse side (or fifing ins6uctions.
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I(We) occupied as aa pr"v�dpal place ot residerce the foAowirg descnbed real popeAy for whirh a Homestead Propaty T�c Gedit is haeby dairred:
��(We) owned ❑ he buyug unda oontract
Have a ber�efidal mterest m the entily Mffi is liade fw 7ie property taues m the popaty ard Cat owns Cie properry or is Wying urMer a conhad
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n parUOn d uie rasiderdial s�ra Q the lar�d nol ecee�re w,e (1) aw tl�a+ "onmeda�y wrra,Ws
propeNy ulil�d b produce uimme.
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Reel PrWertY ❑ Mahib Ffome (LG 61.1-� -
ae is used b peoduce i�oome. des�be the ime �d pwtion
- �.. - ,• • i ' - t� �.T TRUE.TAX ASSESSm VALUE .F101�STEAD q,.,i r3s NON�RESID@i7U1L€'� �'%�
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s�amimd'ag residenhal improvertien�. ( ) ��;3,s'�?J�J,.zi,��:a' 'S�� ��`=i`�€i�i�'as, ai
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Tdal unprovemertts (�are 4 Buough Bne 6) m
Tital value (l'uie 3 pda ffne n (g)
I I�reby certify the above is We. cortect and seree+a d�r Date sqied
arnplete-
Vaiyirg eaian - S'greme of /uidtu Dam signed
. . �.; ST/WDARD DEDUCTION'ALLOYYANCE�' , �i :. 4 + - �-„+ty ,tc .}�( ?"•;r� } �i' :•
r'� � sd.C,., i t eo... s�r ,1�=
20_Pay20_
Lesser of 12 Homestrad
Valuation w 535.000 S
Si�ce o1 N� Da1e s�ed