Homestead_Kermode (3)fORM HC 10 1979
PrescriOM By Stzte BaarE ol Ta� Cammissianer5
To & FileE in DuD���ate
CLAIM FOR HOMESTEAU PHOPEHTY TAX CREDIT FOR YEAR 1922
SEE BACK FOR FILING INSTRUCTIONS
bu��
,(We) ��� �-e-e-- ���>� certify that on the 1st day of
March, 19�, 1, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned � O/_ � D ID� �
❑ are buying under contract «�
❑ have a beneficial interest in the taxpayer
Property Description in � County ��°-' Township
Taxing District (City,-�ewn, Township):
Parcel Number
If buying Ofl contract: Owners name ��� sim0�e av.nerl
or legal description shown on tax statement:
/ 7. o 0 7'y �
�f � /�z /U Gt� ��y� ( .7/1-a-ct 7 � % - � - /o
Contract recorded in Recorders Office - Record No. Page
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property:
�hereby certify the above statement is true, correct and complete.
. / i
AEEresS
vl �
County
Township
�{7�%C�
Ciry. Sw;e ana Zip Cone
` Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY =
True Cash
, � Value
Land not exceeding 1(one) acre immediately
surrounding residential impro�e� � � � (�) �O o
Other Land (2) .S-/ o
Total Land (3) / o i c
Residential Improvements
Other Improvements
JUN 1 �' i979Dweuin9
' ..�:
� � %
�. �; ,i
� •,:
T Improvements - Line (6) plus (7) equals (8)
I�by certify lhe above is true. correcl. and complete.
SigndNre of ASSeswr
(4) / 8�zo
(5) —
(6) / P Sz c
(�) —
(g) /$Szo
Oa;e
Assessed Homestead
Valuation Valuation
/7o i7o
- ACTION BY AUDITOR -
G - � - 79
Approved: ,��,��-�+� Date: G-��7 �
.
Gibson County Auditor
101 N Main
PRINCETON IN 47670
3502
p.�iEfORM!�H�A]lewl
.\��RIT'EOB1 �I�iEM�MO
fOR411A
InJiriJuaL. aiid ina;rinl <ouples arc IimitN to ore hnmeucad MandaN �L�-dunion..4s Ihc rttrip� of �his deduction 6ccomes
mure beneficial, therc i. more incenm'e than a�er for home.rc:Kl &aud Homrstead fauJ causes highrr Ia� bills (or all: therefwe.
HEA 1;4-i-?009 rcquim uipa�en who receire ihe IxxnesteaJ nandard Jniuc�ion io veri�i' IIw1 they are cli�iMe �o recci�c the
benefi� anf to prm�idr aJAitional iJrnniyinc intorm�tiun ixcexmry to allw' counn� grn'emment ro brner ;nwiror IwmrsrcaJ
flinf,v. This in(omuiion will hr l.ryv ronlidrnial anA r.m only M armcsni b� autMr'veJ rmnur nl7iai�aB. The Derannmm nf
I.ucal Gwermnem Fim�rce ��ill u.e ehis informuion �u arcam uwls tha� �rill hcln camrv ufixial. climinm�: hemmsmad fiaud.
Taxpacer Name
Kermode, Harold Lee / Patricia Louise
v
R? i3ut
I'rincctnn IN
Harold Lee/Patricia Louise Kermode �
3027 E CuRice Lane S[ate Parcel Number Legal Description
Princeton IN 47670.8869
I I II I'I I I'I I I I I II ' I I II I II I 26-12-75-200-001.046-027� 006-01046-WPT-E�NNITRACT7 15270 -
in n�i u in niii iu n n i in� i ini n 7.007ACC-1
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1' �
Owner I First Middle � Lui
�/9�a�v ,cr� ��MdD� ;
te Address (number md sncet, city. smtc, ar�d ZIP codc) � $ame as pmperty eddrev �� -
3c�z� ,E� Gi>.P��c LN- }�/NC�7Z�/✓ /�✓ 97l�70 ,
Social $
Spou;c� First Middk ( Lut
�j , �
;J � i^l�� �b viS z '�l�mo�-?�
Mailm�� Address (I�umber and a1eel, cin', sWle, anJ'LIP cu<k) $.+me us pmperty addnss �
� � .OS / �. 1..�_U /'� i c � � � iv � T /' i iNC _�.� C.,. _ f�- -f�?� 7d
Social Stturity Num6cr (lasc 5 dieits) Drivcrs Liccnsd5tatc ID Numbcr Qast 5 digits) O[her (pl �c spccih� in Pan i bcbx�) �
� � ,� �,� :�- �� i
,
Fach undersi�mecl certifies, under penalty of perjuq�, that the above and foregoing infortnatiun is We and correct and that he or she is elieible to
reczi�•e the homes�ead s�andard deduction on �his property. Each undersiened al;o understands that, by claiming additional homeste3d deductions
unlawfully, he or she may be liable for back taxes and substantial financial penalties. �
Own�n �1 Signaturt I�tc '1'cicphme
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