Homestead_Blemker % WE I O*M!3 Be;I 5-tt TPrutilrA FOt•:11A
APPROVED By STOE BMW nr AMA.1.1,."no runaway 111E DEPARnecrw LOCAL CAN'EPNslnet FINANCE h'II-1.1:234 I- - ,
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 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.Ilomestead fraud causes higher tat bills for all:therefore.
HET 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information nemary to allow county government to better monitor homestead
filings.This information will he kept tont:a ntial and can only he accessed by authorized county officials The Dv-panne=of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Blemker, Karen S
/.. 629 S Seminary ST
!/\/y\/`l Princeton IN 47670
3089
_ __ — - -- -
Karen S Blemker —
629 S Seminary ST State Parcel Number Legal Description
Princeton IN 47670-2435
III-,IIttlI llrtI IlltltrlI I I ItIII I IIrtIrII I III F 26.12-07-403-000,200-028 019-00200-00 CLARKSVILLE 19
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
ki-ggn) S. iL-En9 42
�g Address(number and street,city,state,and ZIP code) — - - - Same its property eddress
b 2-9 s; SE/Y�1/>)m2►2 Sf P R i n1 c eC-4v A) nJ 1(7(o?
Spouse First Middle Last
Mailing Address(Number and street,city,state.and ZIP code) ❑ Same as property address
Social Security Number
�/t( . 55dd^i/gits) Driven's License/State ID Number (last 5 digits) Other(please sptecify in Part 4 below)
J ' sou
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 , S` - ' z Date���//0
�t.
FOflM HC 10 1979
ReuriEeE By State BoarE ol Tae Cammissioners
To & Fled in Duplicate
CLAIM FOR HOMESTEAO PROPERTY TAX CREDIT FOR YEAR 191� ,i
• SEE BACK FOR FILING INSTRUCTIONS Q� 9'- DOo1O0 -O'lJ
��(We) C�`-4"'-`�"� �� ��"-�-�'4J 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 interest„in the taxpayer
Property Description
Taxing District (City, Town, Township):
Parcel Number
If buying Ofl contract: Owners name ��� s""o�e owner�
��-%�-*� � Township
or legal description shown on tax statement:
C�.�_�.� � „:�� � �
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.� � l/ .. ., �
SVK�
County Township
and Zip Co4e
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 improvements
True Cash
Value
(�) /C� �O
Other Land � � � � � (2) — o —
Total Land (3) �!o SO
Residential Improvements Dwellin �4� ��
JUN �a a���9 �5� � �{D
��c6� �g
Other Improvements �� (�) — � —
AuoiTOs
T�' Improvemenis - Line (6) plus (7) equals (8)
I�sy certify the above is true. c rrect. and complete.
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Valuation
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