Homestead_Thompson dirt runt!3tt nC!w1 MEASURER 105).111A
.A,reXW BY STATE&MADr*YwtxrS.:Int rtrs,lawnY TIII:DIWKINIENT OF LOCAL famtVNrwT MD:YE IC 6-1.I.2:4.1
Gibson County Auditor
1Q IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
1010b1 Main
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 exer for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verity that they are eligible to receive the
benefit and to provide additional identifying infomuuon necessary to allow county government to better monitor homestead
filings.ibis information will he kept confidential and can only he accessed by authorized county officials.The Ikparintran of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Thompson, Leslie A
RI Box 244 C
Francisco IN 47649
4629
Leslie A Thompson
1801 Lakewwd Circle State Parcel Number Legal Description
Francisco IN 47649
26-13-20-200-000.014-004 002-00014-00 LAKEWOOD HILLS 10/11/12
C-1 D7
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
k_g5l. ii- 1- v % A/ �hornp50/
•ng Address(number and strm.city,state.and ZIP code) - _ __ ____ _. . [] Sense as Trope r tddte s',_-__.— - - — - - —
/ $01 5- / h-lfetooac es'Rel.e 1-1f4gt,'Sto y,, Y7( i-( 9
Spouse First Middle Last
Mailing Address(Number and street,city,state.and ZIP code) El 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)
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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.
Ovine I Signature - - - Date " -
•
•
FORM HC 10 lg9 _ To Be Filed in Ouplicate
Nesaribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 n )
SEE BACK FOR FILING INSTRUCTIONS /00a O�t� �✓
R '\ Ida n� l � hen � `/
(We) certify that on the lit day of
arch, 19-2q-, I, (We) occupied as our principal place of re idence the following described real property for
which a Homestead Property Tax Credit is hereby being •claimed ::
I, (We) ❑ owned . - '?C� - /3
❑ are buying under contract" .
❑ have a beneficial interest in the taxpayer - -
Property Description in County, Township
Taxiing District City, Town, Township): P /✓�X V..
ggllumEr or legal description shown on tstatement:
�iii����.dpq c 3
If i ng ;o�-Cbfitract: Owners name (fee simple
Contract recorded in Recorders Office - Record No. 7 rrrP---age
If anALOAffOR 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: County Township
hereby certify the. above statement is true, correct and complete.
and
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 -
True Cash
Value
Land not exceeding .1 (one) acre immediately
surrounding residential improvements (1)
Other Land (2)
Total Land (3)
Residential Improvements Dwelling (4)
Garage (5)
Total. (6)
Other Improvements (7)
T_o. I Improvements - Line (6) plus (7) equals (8) (8) _
I y certify the above is true. correct. and complete.
Signature of Assessor
- ACTION BY AUDITOR -
Approved:
Assessed Homestead
Valuation Valuation
Date
Date: —