Homestead_Martin (3)FOflM HL t0 19i9
P�euribeC By S�ate Baara ol ia. Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�
io Be Filea in Duo��cate
SEE BACK FOR FILING INSTRUCTIONS
�(We) ���t� , �y� � �-��� certify that on the 1st day of
��iarch, 19�� I, (We) occupied as our principal piace of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) owned �Dtp"D��7d
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in � �j7ounty O� Township
Taxin9 District (Ciiy�ewrt Township): v°�'�`"�
Parcel Number or legal description shown on tax statement:
� /�2 5/ ��c� a-8'�-' /o (�Ai
If buying Ofl contract: Owners name ��� simo�e owneq
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
� .f l 1 i1 �_. �
County Township
5�7� 7
' 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 vne) a�re i�medi lely �
surrounding residential mproaemertfs� �
Other Land
!uu � � tsis
Total Land
Residential Improvemens /�//� ,.-�4,welling
�� ��
'�f—� uGarage
�� AUDiFpR Total
Oiher Improvements
Tr' ' Improvements - Line (6) plus (7) equals (8)
I�by certiTy the above is true. correct. and complele.
Signawre ol Assesmr
Appro
True Cash Assessed Homestead
Value Valuation Valuation
r
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- �j��jjjjj/
(5) �
(6) ��`i7o
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(g) �j S `�7C
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% �� 3�—
� — 8 — %
oai�
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Date: �j_7_�
0
41
ty Auditor
IN 47670
Ratph / Linda Martin
2490 E 350 S
PrincetonlN 47670-8736
I�i��ll���l�ll��l���lll���l��l�l���
InJiriduaL aod in�rriN coupin arc limi�td m onc homevcaJ �andaN Jedu.tion. As �he rttripi of ihis dcduction bttronre�
more beneficial, tMe is morc incenm�e dun ecer (or M1ome.rcad fr�uJ. Ilomnread fiauJ caa�cs highrr ta� billc for a71: thertfae.
HEA I i}3-21NW requims u�pa.m xho r.cei.r iM1c hanesteaJ e�andard dNuction io verilv �fwt they art elieiNe io mcci�c �hc
brnefit ani ro pnn'iJe aiMiitiunal iJrntiiyine in(urmatiun Meo'vn ro allw� eountr go:rmmem to bener monitor humrsre:wi
filim�.'fhis info�mnion aill 6e {.m1 cmlidcMial anA can nnly h• aree:tnl M1�' amMriznt rnuny' oR¢i'vl..l3e Ue�unmenl nf
Lueal Govemment Finance �vill u�c �hfs infurtnuion ro create twls �hat will hcin �wmr ufficials diminak Iromestcad fiauJ.
'�
�g Addrtss (numbcr ond sirtct. city, state, and ZlP code)
a��o . � so s: ; ,.
$ceial
Addre.0 (Numbcr and svtt4 ���y, slaie, and ZII' cale)
Drivds Liccnsc/Sure ID Nmnber (ly� 5
� � %/,; /
Tasoaver Name
Martin, Ralph / Linda
Rr?Ib.t
State Parcel NumAer Leoal Descrip�ion
26-12-28-400-001.240-027 ooiro12a0-00 PT E SE � 28 210 3 AC
D-10 �
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1-1 Samc:a pmperty azldte�
LT
bclow')
Each undersigned certifies, under penalry of perjury•, that the above and furegoing inFurtnation is we and colrzct and t}i•rt he or shi; is eligible to
receive the homestead siandard deduction on �his 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. i
Uj.� �r $ignatur< �p�- Dnte
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