Homestead_KoeningFO0.M NC 10 1979
PrescriOeE By Statt Boara of ia. Cammissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 � y
To Be FileO fn Duplicate
t�t n SEE BACK FOR FILING INSTRUCTIONS
�(We) �- I`.}� �' certify that on the tst day of
March, 19 8�—i', (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) C�Owned /� m /�
❑ are buying under contract ��1p — �/D3a '7
❑ have a beneficial inter st i,g n the taxpayer � _,._ /
Property Description in i��� ��-��"" County �'�`�-' Township
Taxing District (CYfy�ewn- Township): �'�-^-
Parcel Number or legal description shown on tax statement:
� }��4- nl w��'�i- a�- Z- i i t. S I Q_c_.
If buying on contract: Owners name ��� simple
Contract recorded in Recorders Office - Record No
If any portion of the residential structure or the land, not exceeding one (1) acre that immediate�y surrounds that
structure is used to produce income, describe the use and portion oi 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.
County Township
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 -
Land not exceeding 1(o c e immediately
surrounding residential im��e� �
Other Land
Total Land
1�lATt � � U�
Residential Improvement ,pwelling
�ia o•�'�-��fiarage
AUDITOR
Total
Other Improvements
;� Improvements - Line (6) plus (7) equals (8)
I �,ereby certify the above is true. correct. and complete.
Signamre ol Assessor
True Cash
Value
(�) -� °a
(2) / % o
r3� G 9 a
(4)
(5)
3 500
�c 7 0
(g) `f o `7 0
(7) / o � o ,�
(8) S l S o 7- / 7�-�
Assessed
Valuation
/ 7 0
Homesiead
Valuation
/70
- ACTION BY AUDITOR -
Da:e
a.�,-. :, �. t 5 S Z--
' `3-3Q^ �a
Approved: �- • � • *-�-�- Date:
1 _��
$TATE FORM SJ569 (R�8-09)
TRFASURER F02U TS-IAI
APPRO\'ED BY STATE BOARD OF ACCOU�TS, _'009 PRFSCRIBED BY TNE OEPARTUE.�T OF LOC.LL GOVERI:NE�T FITA:V('E IC6-I-I-'_'_-9.1
� , � , 1 / . 1 1 � , 1 � , �
Indi��iduals and married couples are limited to one homestead standard deductiou. As the receipt of this
deduction becomes more beoeficial, there is more incentive than e��er for homestead fraud. Hornestead fraud
`auses higher taz bills for all; therefore, HEA 1344-2099 requires taspa��ers �r•ho recei�•e the homestead
standard deduction to verify that they are eligible to recei��e the benefit and to provide additional identifying
• information necessary to allo«� counh� go��ernment to better monitor homestead filings. This information
will be kept confidential and cau only, be accessed by authorized county officials: The Departnient of Local �
� Go��ernment Finance will use: this information to create tools that ��•ill help count�� officials eliminate
' - - homestead fraud:
�� �� �
Tazoacer �'ame Procern' Addrns Slate Parcd \vmAer Lreal D<scriotion:
� �5-sv 3 S-o ts�
Sharon S Koenig / 26-1 I-22-100-00032a-027 006-0032J-00 PT NN' 22 2 11 1.81
Princeton [N 47670 v � AC 0.17
/� �Complete and return !o: �
CIBSON COUNTY AUDITOR. 101 N D7AIN PRINCETON IN 47670
�• 1
O.vnu f First AtiENe Last
Sha r� h �u � :�e en � g
Mail'ug ACtlress lnunDC aM suEl1, aN. �te arM ZIP wEe) �
�G(112 d5 plOpCl�`J d�f2S5
Sodal Securiry Nurtbef �last 5 dlplb) Onvels License $tate 10 NurtCer (WSt 5 dlplLS) sme Omer (qease speciry in Pan a edow)
(� � �
S{,wse � . First � . ' . ' . ' . . . Middle- . • . , last
��9 �� (+u�� � sveet. tlry. state anE ZIP catle) ❑$�� � pr�y atltlress
Sooal Seamry taurzea (last 5 mpiss� pivels Licmu Stare ID Nw�ta (last T5 Elgln) s� ase� �pease soeory �n van �� eao..��
I Im
Each undersigned cerlifies, under penalty of perjury, that the above and foregoing infortnafion is We and correct and Nat he or she is eligible ro receive tne
homestead standard deductlon on this property. Each undersigned also undersfands that, by daiming addifional homestead deduc6ons uolawfully, he or
she may be liable fw back taxes and substantial finandal penalfies.
Owner 1 Sigru�ue D9te iHepfmne
Q�.� � 5-, 3_ d � _�� -
Spwse Si<yuNre Oate Teleptqne
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