HomeMy WebLinkAboutHomestead_Fortner (4)FOFM HL 10 19r�.
PrewiGeG By State BaarO al 7a+ Commissioners
to Be FileO in DuDlitate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 192�
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SEE BACK FOR FILING INSTRUCTIONS O�ry_ OO A� /� D O
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•�(we) �O"L/�vzQ2% ,�"L�t.€-l� a /�i.�Dz
�arch, 19_� �_, I,�(We�upied as our principal place of
which a Homestead Property Tax Credit is hereby being
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial intere,st in the taxpayer
Property Description
Taxing District (City, �eNm� T.�was+�t�): ���
Parcel Number
If buying on contract: Owners
ow�e,i
certify that on the 1st day of
the following described real property for
,��� - Township
or legal description shown on tax statement:
���a
�
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.
�
County Township
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 i�ro � ment� � �
Other Land ,
Total Land
Residential Improvements ,!i,�•'•' = � ��a79 Dwelling
�,% / .Garage
r'��S' t! �_p�,Qtal
Olher Improvemenis /�� qUDITOR
Tr Improvements - Line (6) plus (7) equals (8)
I�by certi�.p-�ie-above is true. correct. and complete.
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SigNlulP OI FSSPSSOI
True Cash Assessed Homestead
Value Valuation Valuation
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- ACTION BY AUDITOR -
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Da:e
—�Y—
Approved: �'� '�� Date:�� � 5 7 9
Gibson Counry Auditor
101 N Main
PRINCETON IN 47670
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SIAR FORN �"M IR'/!-W I IALAltiIER W0.4 �}.IA
n��Mw'EOBYaI�IEM�RD(NMn'�:�T.:nv PIlf9(WOf➢�TIIIfU[YMMf.Yf(ifIPiALC.IM'cR.VMlKIiP:1fE11'��.I-L-J.I
Indiciduals auJ marriN couplp arc limiinl m nnc hn�ne�ead uandaN Jntui�inn. As ihc rttcipi ol'this dnlunion beconree
n'�ore beneficial, there i. morc incencire thm e�er (or homesieacl (nud Iloniestead tnwl causrs hi�her �a� bills (or all: theref«n.
HEA 134i-?(H19 rcquirn Liipasen xho receive Ihr hanes[mJ slandard Jnluction m vcril4 Ilu� �he�' am eliciMc to reccivc Ihc
brnefi� aN to pM'iJe aJUi�iunal iJrmih'inc infwmmion neccvn� to allw' ewnq' gucrmmrnl ro W.:rcr momtor homestt:xl
Iilim2'Ifiis inlnrmaiion will M{.ryr rnnlidetuial anA cnn nnly h. a�re: �eJ Ap aulhnriinl rnwn�� n(Ttials- "I'Ae IXryinmmi nf
Imal Gmemmrn� fivm�e ��ill u.e �his infonnmion m areae cnil. Out �oill hdn iv�nrv ufficiala diminam Mme.tcaJ fraud.
Trsoacer M1ame
Fortner, Dortha Mae Life Est Etal
Propert�� Addresti
I 12 7hirt1 Avrnue
I'rinccton IN 47570
1533
Dortha M Fortner
112 N 3rd Ave State Parcel Number Leeal Description
PRINCETON IN 47670-1010
--- _ 26_11-12-104,000.891-028. 01�-0oea1-ooTOWER HGTS 90 _ _ _ _ _
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