Homestead_Hart STATE FORM!)SMIR_I WO TREASSLER maN TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.a.+ PLESCPIBEDOT nit DEPARTS2Yr OT LOCAL CAKERNMFTT FINANCE IC 0-I.I-2T-ST
Gibson-County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead aandar d deduction.As the receipt of this deduction becomes
_ more beneficial,there is more incentive than e'er 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 are eligible to recent the
benefit and to provide additional identifying information net—s. ry to allow county government to better monitor homestead
ffi linen.This information will be kept confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will h:Ip county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpaver Name Property Address
_ Hart, Bobby Joe
i— 305 Delaware
Princeton IN 47670
87
Bobby Joe Hart
305 Delaware State Parcel Number Legal Description
Princeton IN 47670-3431
�t tt��� ��t t�tt�tt��tt tt����rrt t�t�r��rFr� 26-12-18-304-001.094-028 019-01094-00 BROADLEIGH PARK 136
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
RoJ, Ay Jl o9 HART.
'•Ig Address(number and street,city,state,and ZIP code) - - — -- ---- ij me as property uddros- - — — - -- - -
306" OrtguvAn ,Rnir fl N IAI 1/7k76
Mailing Address(Number and street,city,state.and ZIP code) 0 Same as property address
•
Social Security Number(last 5 digits) Driver's 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.
Owner I Signature Date
•
FORM HC 10 19i9
Prescri�ed By Siate Board oi iaz tommissionees
To Be Filed in Duplicaie
CLAIM FOR HOMESTEAU PROPERTY TAX CREDIT FOR YEAR 19�� �
SEE_BACK FOR FILING �If��i}JCTIONS D(9 - D/0 9�/- o �
We) �`" certify that on the 1st day of
...,,rch, 19��_, I, e) occupied as our incipal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I. (We) CS�owned ,
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in � County �r-�-�--�-u�' Township
Taxing District (City, Town, Township): �-p-2�1�iY.. Qn��!✓ .r'
Parcel Number _ or legal description shown on tax statement:
i3 G
If buying Ofl contract: Owners name ��� simo�e owne��
Contract recorded in Recorders Office - Record No. Page
It any portion of the residential structure or the land, not exceeding one (t) 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.
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' 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
surroundi re enti imp em�
Other La� �
Total Land
Residential Im�'}{vl�rr�r�s!979 _
�/1 � i j����a_(�
Other Improyements AUDITOR
True Cash
Value
(1) �70
(2) �
(3) 270
Dwelling �4� �' `�
Gara9e (s) �
Total
Tr'-� Improvements - Line (6) plus (7) equals (8)
I�by certify the above is true. correct. and complete.
�
ol A55¢Swr
( 6 ) l ,�..(.-5�e-
(�) ,� �
(8) ��'� U
ION BY AUDITOR -
Assessed
Valuation
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Date
Homestead
Valuation
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Approved: � u �l�e� Date: g//
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