Homestead_Hartley SIAM EORM!1'M IR_/HMI TREASURE,FORM 11A
APPROVED BY AVE BOARD Or MYYiNTRa, PVS[WBW BY nir nrenromerror LOCAL r rsNMEKT FINANCE IV i.1-rJ.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
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 eser for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
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FIFA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information nemsarr to allow county government to better monitor homestead
filing.This information will be kept confdentinl and can only be accessed by authorized county officials.The Depannsent of
Local Government Finance will use this information to create toots that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
• Hartley, /Nancy A
•
518 S Seminary ST
Princeton IN 47670
1122
Nancy A Hartley
518 S Seminary St
Princeton IN 47670-2434 State Parcel Number Legal Description
26-12-07-403-000.544-028 019-00544-00 SUM ADD 4
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
Spouse First Middle Last
,1/#10)7 te74r r/ #1,7-7E/
Mailing Address(Number and street,city.state.and ZIP code) p�/ ®Same as propeny address
f/7 S&,,r ia,�e/ fir. #1,10 67-0.4) 1. -1/767d
--- '--' `- '��'- —. -- --"
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.
1
e%�'3� CLAIM FOR HOMESTEAD PROPERTY TAX
i'�''r CREDITISTANDARD DEDUCTION
�� Slate Form 5�73 (R2/ 5-92)
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INSTRUCTIONS: See reverse side lor liling inst�uc(ions.
FORM
HC10
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YEAR
�
I�we) Vi certity Ihai on �he 1 st day of March. 79
�) occupied as our principal place of residence ihe following cribed real properry tor whi a Homestead Pr Ta Crg�ii is�reby claimed:
J
V 1(�Ne) owned ❑ Are buying under contract :�,I_IO� �(1�j
❑ Have a beneticial interest in the entiry that is liable for the propeny taxes on the properry and that owns ihe propeny or is buyinq under a contraci.
CONTRACT RECORDED
II buying on comracL Fee Sfmple owner's name
Recortler's office where comract is recortled Record number Page
Counry
Parcel number
I'� nion o� I the resid
of the propeny utilized to
Township
Legal tlescription
strucNre or the lantl not exceetling
ce inwme-
PROPERTY DESCRIPTION
Taxing tliSiriC� (cily. (own, ;own5hip)
aae Iha� immetliately su« ounds Ihat SlmcWre is used m produce income, tlescribe the use antl ponion
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Couniy Township Counry Township
�=by cenity the above statements are true. correct and complete. S�g�-wre o� ctr�ma
/� /)
�;: �.�
Atldress (number and street. ciry. s�ate. ZIP code) •
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
land not eaceeding t �one) acre immediatety I, ' I I
surrounding residential improvements. '
Otherland (p)
Total lantl (line 7 plus 1lne 2� I(3) � I
Dwelling (a) I I
Residential improvemenis
Garage (5)
Other improvemems (6)
To�al improvements (line d fhrough lina � I(7) I I
Total value (line 3 pbs line l I(8) I I
I hereby ceriity ihe above is Irue. Correct. and I Signarore of Assessor I Date si9netl
complete.
V�eritying action - Signa;ure ot Autliror Date signetl