Homestead_Smith (33)FOBM HL t0 t9i9 � To Be FileG in Uuo�icate
P�escri�ea By State Boam al ia� Commissfoners
CLAIM FOR HOMESTEAO PROPERTY TAX CREDIT FOR YEAR 19�
SEE BACK FOR FILING INSTRUCTIONS
�(We) ��-'-�� ''�"�'"""`- �����-�---�- -A'• certify that on the 1st day of
arch, 19� 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) ❑ owned
❑ are buying under contract
❑ have a beneficial inte/rest in the taxpayer
Property Description in �%i b S o"i Cc
Taxing District (C�tq;--�avvr,rTownship): r'"�TOKA
Ob�' d �$�g
�ATCk�
Township
Parcel Number or legal description shown on tax statement:
r-i'. �o-c_ � /i /- i o ��. 9GA)
If buying on contract: Owners name �'� $inp1e °'""ef�
Contract recorded in Recorders Office - Record No. Paoe
If any portion of the residential structure or the land, not exceeding one (t) 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: County Township
�hereby certify the above statement is true, correct and complete.
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(one) acre immediately ��
surrounding residential impro�en� �
Other Land .
Total Land
Residential Improvements
Other Improvements
T ' Improvemenis
I �by certify the
Signawre ol Asseswr
1�„N i 9 1979
Dwelli g
� �"l'�
,�
Aif��o�
- Line (6) plus (7) equals (8)
above is true. correct, and comple[e.
�ii i��;-i
t
True Cash
Value
(�l 3G o
(2) 9a
(3) Syo
(a) /� 8 / o
(s) —
(g) /� S�C
c�� —
�g� /� 8 i c
�i iniTnR _
Assessed
Valuation
.
i -�
�!� - -
���������
��������
, _
67c
Homestead
Valuation
/ �o
�(o-�o %
/_� �_ �
(c - /'i- 7
�:z
Date: � �/�___�—
�
.
Gibson County Auditor
101 N Main
PRINCETON IN 47670
1107
�
• M�`SU�IA fOR�:�31A
N«t.�TS._nw Y1.FY(NBRIBYiIIfPE�MiM�`I�UFLIX_4LIXY�2R.VMfA'tiA'lfE1CL1.1.E_�I.I
IndividuaL. and inxrieJ muple� a¢ limi�ed �o ore homeucaJ �a�aN Jsluc�ion..4s the �cceip� ol this dcdunan bccoma
murc benencial, thrrc i> morc fncmtnx tlwn ecer (or M1omesrcad tnud. Ilome�Yeml faud ca� hi�hrr la� 6ills iur all: therefore.
HEA 13�f-i-?IX!9 requim u�pa.en w�ho receirc ihe hanencaJ s�anduJ JeJunion m veri(�� tha� �hcy are eliciMe m rccei.e the
benefi� and to pnn'idr atklitimul idrntiirin� infi�m��non riea�an� �o allw' counn� em'rmment �u be�er mmitw Iwmcsttal
filin��. This infmmation x�ili he Aryw conCdcniial and e�an nnly bc aeres.ed br autMrivcA rounry� nRciols,'!he Dcpanntcnt of
Robert P/ Katherine J Smith
R 3 Bax 214
PrincetonlN 47670-8536
�i�u��in�i��n�ni���ni�n�n�i�iu��n��n��in�in��n���
. � .
Taxpaver Yeme Prnoem� Address
Smith, Robert P/ Katherine J `
f
R313ox �I�
�
� cetonlN;7670
�
!
State Parcel Number Leeal Descrip'tion
26-05-40-211-001.818-02��1a7a-ooPTLOC277110 2.96AC
C-1 i
. . - �(JI.Mi�
end "LlY codr)'— -- _ _ .—_ _ __ _
°? W °� �.5� �
I$
��
- W 2�S N J�Y 7 0
Itturin� Numbcr (lase 5 digies) Dm•ds Licensc/Slaee ID Nianber Oa;t 5
0
�Sum. u. pmpery ai.'wcv'— —
specif in Part 4 [clow)
Middlc � � /
� �'v"""
� Same u pmperty addts.
Part? bclow�)
undersiLmed certifies, under penalty of perjury, that the abo�•e and foregoin� informatiun is we and correct and that t
+e the homestead standard deduction on this propeny. Each undersi¢ned also understands that, by claiming additional
Jfully, he or she may be liable for back taxes and substantial financial penahies.
I SiFnewrc ' Dste
� �YL✓7< � �{ .1. ( o �
or slie is elieible to