Homestead_Bolden _ • 51VE FORM,M1.0CI YOI mssu mFORMi-lA
ARrfl roaY 5141E MSROOF VTYR]N15.Tw ranniaDnY mC OFPAREWyr(i L AL nM TronlFEAsCEM1i1-rai
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 eser for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 1344--2009 requires taxpayers who receive the homestead standard deduction to verify that they am eligible to remise the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kept confidential and can only be accessed by authorized county officials The Depannent of
Local Government Finance will use this information to create cools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Bolden, Clyde C/Janet P Jones Life
Est E
403 N Spring S'I'
' Princeton IN 47670
1616
Clyde Bolden
403 N Spring State Parcel Number Legal Description
Princeton IN 47670-1207
illii Fttltllldililll 'IFFIFiiimllttllj lilt Fiiri A 26-11-12-204-000.210-028 • 019-00210-00 EMBREE ADD 11/16 PT
PART 2:TAXPAYER INFORMATION
Ow I First Middle _ A^— Last
� A - (number and itreet.city,state,and ZIP code) 4 - 2 Same as propery address-— — - -
4-03 IV / Ci-�'�. X7676? --
Spouse ^ - ^ r ^^ / First . , . Middle Last
Mailing Address(Number and street,city.state,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
sus
PART 3:CERTIFICATION j
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.
Ow Signature Date
•
���„
aE _° 4 CLAIM FOR HOMESTEAD PROPERTY TAX
i��': CREDIT/STANDARD DEDUCTION
���� State Form Sa73 (ft2 / 5-92)
���
iLi �
INSTRUCTIONS: See reverse side lar (iling instruc(ions.
FORM EAR
HC10
e) _ __ V(.1J(/ �� � . certify ih dn iFt'¢ 1 f h 9! �-�
e upietl as our p, cipal place of residence the tollowing described r I pr y for which a�H estead Property Tax Credii is here�by daimed:
I(We) owned ❑ Are buying under coniract - ��+�9! � ��"" •
❑ Have a beneficial interest in the entiry ihat is liable for the property taxes on the property and that owns ihe property or is buying under a contract.
CONTRACTRECORDED
It buying on contract, Fee Simple owners name _
Recorder's oHice where coniract is recorded Record number Page
" PROPERTY DESCRI TION
Counry Township Taxing tl, ir" �, m n, ^ hip) -
P I u r' � Legal tlescription /
It any portion of the resWential simcture or ihe land not exceeding one (7) acre tha� immediatety surmunds ihat strucNre is used t oduce income, d i th use ai
of the property utilized to produce income. '
ASSESSOR USE ONLY . TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
land not exceeding 7(one) acre immediately
surrounding residential improvements. (�)
Other land � (p) �
Total land Qine 7 plus line � (3)
Dwelling (4) .
Residential improvemenis
Garage (5)
Other improvemenis (6)
Total improvements (line 4 through lina � (7)
Total value (line 3 p�s line 7� (g)
I hereby certity the above is true. correct, and Signamre ot Assessor Dare signetl
complete.
mg action - Synamre of Autliror Date signetl
STANDARD
19_Pay79_
Lesser of ll2 Homestead
Valuation or 52.000 S
SgnaNre of Audimr
�.— �i �