Homestead_Stallsmith STATE FORM 53369(R3IS-10)
TREASURER FORM TS-IA
APPROVED BY,STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE ICS I.1-2?-9.1
tCe iVIPORTANT;NOTICE TOPNOMESTEADSPROPERTY::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
auses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
s 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.
t>r ' a PARTI:"PROPERT% 1NEORMATION
Taspaver Name Proper Address State Parcel Number Leal Description: -
Gregory F Stallsmith 11369 S OWENSVILLE RD 26-22-10-100-002298-024 PT NW 104 1I I AC
UAUBSTADT IN 47639
Complete and return to: I®IIII01 11 Enna]I1 IP IH1111�IllllflU�DfUl®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 LL� 1 111 1 1L 1
'a} .:PART 2:TAXPAYER INFORMATION
Owner 1 First Middle Last
G c,QcoC S \\\S-Nnnt.
Address Number and=eat,city,state and ZIP code) I Same a property address
\\ 3 (:)C.\ -C)Ns.) v\\\sue `(gyp \�q,r■bSts 5 3c\
e First Middle Last
Mat Address(number and steel city,state and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivels License/State ID Number(last 5 digits) Slate Other(please specify in Pan 4 below)
PART 3: CERTIFICATION'
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
92012
�
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDff/STANDARD DEDUCTION
� >:xe r-w�, s�r.� �� i s os�
?� ey a�e o�,a�,�,� �r ��i coyen.�.,x F�
INSTRUC710NS: See iaver�e side lor filing insbucGons.
� � il . � . CERTIFlCA71ql
1 �_ � i ;� r�.
;�"� , !I i•� �
� /
� ' 11� �
��
�(�'�e) r �(d�.v.C/�/�7 � __ certifY that on fhe 1 st day oi March, 2f1_
�I e) oazipied as n 'ndpal plaa cd: esidence the fcM1-n.ing descfScrl m.,S propr.:�.' for whidi a Hortwsfead Property Ta Credit is hereby daimed:
� (We) owned ❑ Me buyug unda cantrad
Have a benefidal mterest in ihe entiry iha[ is liade for ihe property lues on ihe property and tl�at awns ihe property or is buying under a contracL
� . - _- . . .�CC1�fIFACT-REGCn'aZED•�: .. ..� � ,: : ' . �
. , , „ � _ r, . . . ..: . . . , . ,. .,
rc 4,yug nm m�vacL Fee Sirtryle amers rmme
f�mdds o16ce where mrNad is rrcvdad Re�d mim6er Page
. .. ... : ,_-. . . " . . ..'. '..,'.�-�,"' . PROPERTYDESCRIPT70N�. , . .. . . ..,.. : . . .. :...._r. , ..
' ' r � -. '
�/' Tuv�ship Tami9 d' dY. 6�wn, t ')
�4 �
Pa,cel L " � � Ls the •
� o? ' � /0 —'�" —// � Ram a�y ❑ Mmb rw� �i.c. sr. �-n
n ary �eo� a u,a ��eiai sww.e a me w,e �,d ��„yy o�e (i� me n,a+:��y a,�,w��ds�ne �s �see m p�od�,oe:�mme. a� u�e �se �d �nco�
d me poperly� �o omduca imm�re.
j � � 1. 'a
�� ____':iIWDARi1.�OFrit;i�TlpNl'�.J_fXvayCL � .�.,i - _ .°r ___--
I ., �p.-P�.�-- . _ � �
Lesser of 72 Homes�r.rrf !
Vehlatian w 53.5.On0 I S