Homestead_Fortner (5)FOflM HC 70 1979
Reuribe0 By SUte BwrE ol TaK Cammissioners
To & FiIW in OuD����e
CLAIM FOR HOMESTEAD PROPEHTY TAX CREDIT FOA YEAR 192� ✓
^SEE BACK FOR FILING INSTRUCTIONS CJ�CI _ O0 $j'L�C,. pp
�(We) ���-���+ �;��� %� b���, �- certify that on the 1st day of
�iarch, 19�, I, (We) occupied as our princip place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) JG4fowned
�❑ are buying under contract
❑ have a beneficial terest in the taxpayer
Property Description in _���-� County �� Township
Taxing District (City, Tewrt, Townsbi�): /-�
Parcel Number
If buying Ofl contract: Owners name ��� simo�e owner�
or legal description shown on tax statement:
�� %�� Q 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: County Township
;h by certify t a ove statement is true, correct and complete.
(�`�` - f W. ;st 3 �i/Jck�N y0
'SignaWre Street AGEreu Ci , State ana Zip CpEe
' 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 -
Other Land
Total Land
Residential Improve�nts� � '�' � Dwelling
Other Improvements
T �' �mprovement7
I �!by ceriify.�he
Sig�uture oi nsseswr
Approved
Garage
,�UN ; F 1979 Tota�
UI s��8)
is true. c@f��{-��nd complete.
True Cash
Value
��� � 0 3 0
(2) —
(3) � O 3 0
(4) ¢L�[r
(5) � �Q
(6) �
c�� —
�s� �
- ACTION BY AUDITOR -
. .•
� , .
..
�j�j�j/�j/
%�...%%/ /
/%%%i/i/%% �/�
.—.
oa:e
Homestead
Valuation
.
��jj��jjj
j/�jjjjjjj/
jj�jjj�jj/
�%��%�i
////�/!� //./ �/
_ • -.
ti -�i y—
Date: _� .� 7- 7� �'
ai�reincw!�w�x:is+H�
-_.__-._.__.__.-__..._..__ ..'"""'"—_....___'_"_".'__""___._'_._...___'_._...__...
. Gibson County Auditor
101 N Main � � � � � � � � � � � � � �
PRINCETON IN 47670 InJividuaL. and ina:rinl mupk. are IimiiN io one hmneuc�J standaN deJuniai. As Ne rmtipi ol this Jeduninn becomes
� morc beneneial, there is more i`rcrntnx tlun r�er fer M1ome>iraJ fnwL Ilo�ead fiaud caa�et hiFher tac bills tor all: therefore.
HEA Ga-i-?IN!9 requim u�parers x�ho ra-cci.c ihe hMnesteed sun&rd JeJuction to .eri(y Jut �hey are clisi6le �o rceene the
brnefil aN ro prtwidc aAAitional iJmtifrinc inWrm:itwn necr.mrv ro allux� counry� gwrmmem ro Y.ner moniror homes�e:W
filinf,�. This infomulinn v'ill be Amt cmlidcniial anJ r.m only h. acros+cA M aWhori�nl rounq' niliaiul>'fh< IkyuMxm nf
Lual Gm'cmment fim�rcc ��fll u.c �hfs inturmanon m crca:c Nul. tha� will hdp cwnn� of&tia� dimi�um homcsrcaJ fiaud.
. ' , , , , "
� Tazpacer Name Properh' AJdress
Fortner. Robin L/ Joan E
? I S ��' ��'alnw ST
Prince�on It� 47670
2563
Robin L/ Joan E Fortner
_ 215 W Walnut ST—_ � _ — _ . - . - -
Princeton IN 47670-1429 � - State ParcefNum6er Lesal Description
I I I� I II I 1III 1II I I11I II I 'I I' i I' 26-12-07-104-000.844-028 019-OOaaa-OOOLDP�nN90PT
\
1
Owner I First Middlc Lazt
obi L. -z�r�1�2
e:.Jdr�(uawb.rw�di:meCCi:j:smr:a.�dZ{Pco!e).—' _' '. —'— -.. '_ . _ 'Seme�7mperty.oddrecs — -'
2 is ca. cJA�aU �— �. 2 nJc� �� o
Socml $ecuriq' Numher (last 5 dicits) Driver's Lica�se/SUtc ID Nwnbcr Qav 5 digits) Otha (plcue specify in Pan 4 bclaw)
Spou;e First Middlc Latt
-.� OA ►� � � l=�"��2
Mailine Address (Number and sUtt4 ��)', state, and LfI' cotk) RI S:ime ns pmpem addres
I��
Social5tturiry Numbcr Qact 5 digi�s) Drivcr's Licrnsc/Stare ID Nwnbcr Qa�,c 5 digits) Other (plcnsc spcci(y in Pan 4 bclow)
.. . �
Each undersit,metl certifies, under penalty of perjury�, that the abo��e and foregoing infortnation is we and cortect and that he or she is elieible to
receive the homesiead siandard deduction on this propeny. Each undersicned al>o understands thaL by claiming additional homestead deductions
unlawfull} he or she may be linble for back taties and substantial financial penalties.
Ouner I$i tlue Date 1'clephonc
� �3/.0 (
�� � �• �