HomeMy WebLinkAboutHomestead_ChavisFOFM NC 10 1979
Presui�eE By S�ate Board ot iaK Commissioners
CLAIM FOR NOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�_
SEE BACK FOR FILING INSTRUCTIONS
io Be Flea in Ouplicate
�
0�9- 00397-ofl
� (We) —�`�"�-'�^-' � �C�� ' � �''�"�`'`^`'O-J certify that .on the 1st day of
rvlarch, 19 I, (We) occupied a ur principal lace of residence the following described real property for
which a Homestead Property Tax\�� hereby. being claimed:
I, (We),� owned
❑ are buying under contract
❑ have a beneficial intere t in t�r
Property Description in r
Taxing Districi (City, Town, Township): ��
Parcel Number
If buying on contract: Owners name "� ""'°1e °""e"
�� Township
1 ��J '
or legal description shown on tax statement:
l�V LtJt� `�J.��-�r' �"-�-��'_' 9 � .
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.
y
suee�
[�J
County
Cny.
Township
Zip COQe
' Individual either owns or is buying under a contract that provides he is to pay ihe 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
Other Land � � � � �
Total Land
Residential Improvements
Dw8lting
,i��t 5 -
Garage
/ {otal
Other Improvements �.�I
T%�'�' Improvements - Line (6) plus p) equals (g) AUDITOR
I`�by certify the above is true. c rc(Y�ect. and comple�e.
Signawre o� nssesso�
- ACTION BY
True Cash
Value
(�l %PO
�2) _ o _ -
Assessed
Valuation
�30
—�-
Homestead
Valuation
�3 c
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Date: 7 �- �
STATE FURM S1569IR1B-10)
MPRO\'FD BY' STTTE BOARD OF ACCOU\TS.!009
iRE.1$URER F02N TS-IA
PttFSCRIBED BY THE DEPARTME.\T OF I.00AL GOYFRYME.V� FL�;qNCE IC61-I-_'_'-B.i
� , � , 1 / . , / � , I � , �
Indi��iduals and.married couples are limited to one homestead staudard deduction. As the receipt oGthis
deduction becomes more beneficial, there is more incenfive ttian-ever for homestead fraud. Homestead fraud
�, uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the'homestead
dard deductioo to verif�� that they are eligible to receive the benefit and to provide additional identifying
information uecessarv to allo«� counh� government to better monitor homestead filings. This information
«�ill be kept confidential and ca� only be accessed by authorized counh� officials. The Departmeot of Local
Government Finance will use this information to create tools that will help counh' ofBcials eliminate
homestead fraud.
.�, �. �
Ta�vaver Y�me ` - ' Procern' Address Slah Parcel NamDer Leeal Dncrivfion:
Barbara J Chavis 609 N FORD ST 26-12-07-20?-000397-028 R'ARNOCK SUB DR' 9
PRMCETON IN 17670
Complete m�d ren�rn to: -� _ �WII���II��OIIJ������D�wJ0���11:OW1�W�1131�0�1111
- • GIBSON COUI�TY AUDITOR. 101 N il1�U1V PRL�iCETON IN 47670 "" �
o+na i Fusi r.tiarne iau
�. �b a,r c�. � e,� . C. � c�.v t. .
Maling Address (nurtEer anE WeeL ay. slate an0 ZIP mEe)
�/Same as prapnty aedress
u
io � f S l� -� d , il Cn
so�i s�y M,� ro�� s aroio> a;�r: u�s�ce in rm�,e« �u�t s maial swe omg cp� w�H � aan a n�Q«�
� / :
..-�e . First � / � / . Miaale Last
Maili`g ACCress (nurt0a antl Wee4 tlry. state arM ZIP cotle) ��� as propeM1y aedress
$odal 5ecunty Ntmber (6st 5 Elplb) Orivefs Licensel5tate ID MsDa (bst 5 AIBIts) 9se �v (plpase speofy in Pirt 4 EHav)
� m
Each undersigned certifies, under penalry of perjury, that the above and foregang information is We and correct and that he or she is eligible to receive the
homestead standard deduction on this property. Each undersigned also understands that, by homestead deduclions unlavrfully, he or
she may be liable for back taxes and substantial financial penalties.
Qma 1 Si9�nae Date TNephone
. . ^..".
- o!_ � . (
Spause S}y�ahae � Date � Tdeptwne
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