Homestead_Jackson STATE FOtM55 tS tIL-/■-.•11 mRFAS11IER FORM SIA
runup BY nir F
�*EIMPORTANT NOTICE TO HOMESTEAD PROPERTY ROWNERS
1_a
Gibson County Auditor
101 N Main
PRINCETON IN 47670 Individuals and married couples arc limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than ever for homestead fraud.homestead fraud causes higher tae bills for all:therefore.
FIFA 1344-2009 requires taxpayers who receive the homestead standard deduction to sera y that they are eligible to reeeise the
benefit and to pnwidc additional identifying information necessary to allow county eocernment to better monitor homestead
filings.This infornatinn will be kept confidential and ran only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Jackson, Juanita F
1801 Outer S Main ST
Princeton IN 47670
3959
Juanita F Jackson
1801 Outer S Main ST State Parcel Number Legal Description
Princeton IN 47670-3405
��t r�rt���t rrr�r�r�� Redid
26-12-18-304-001.339-028 019-01339-00 BROADLEIGH PARK 13
� /�'/�� PART 2: TAXPAYER INFORMATION
Owner\ J2���''V✓`f�� First Middle Last
t A ess(numhcr and sweet.city,crate.and ZIP code) _ _
f 0/ s/ Ckn- 574 itLa
Spouse First Middle Last
•
Mailing Address(Number and street,city,state.and ZIP code) Same as property address
ISocial Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
Sate
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
waM nc io iem
PreuriEtO By State BoarE af Tax Commissioners
To & FileO in WDlicate
Ql°��CLAIM FOR HOMESTEA� PROPERTY TAX CAEDIT FOR YEAR 19� /
�� SEE BACK FOR FILING INSTRUCTIONS ��g'- ��3.39` ��
�,We) ��a �� S! ��'-k-Q-�-� certify that on the 1st day of .
arch, 19 I, ( ) occu d as our principal ce of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) Iaowned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description
Taxing• District (City, Town, Township): Tit
Parcel Number
If buying on contract: Owners name �'� $inp1e °"ne`�
`�� Township
or legal description shown on tax statement:
�� �t _i �,
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, correctland complete.
s�.re� nm��
County
Township
ena Zip CoGe
ual either owns �r 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 -
, True Cash
� Value
Land not 9xceeding 1[i�P)�cre�me�ely�
surroundin residentia�im r em (�) /U4o'
Other Land (2)
Total Land
,;UN ? 2 1979
Residential Improvements
�/ ��
Y
����i�i1� d'^,"� `�w e I I i n g
arage
AUDITOR Total
Other Improvements
T�' Improvements - Line (6) plus (7) equals (8)
I�oy certify the above is true. correct. and complete.
OI Asse550r
(3) /a 90
(4) �70.�
cs, a 3'-�so
(6) �-(r7-0-�
(�) —
(g� p o
Assessed
Valuation
3(� �
���������
uiai /iq�ii./
%�//i,,:°'i�!!
- -�� �i �����
• jjjjj�j��/
yD
Homestead
Valuation
S-Z/-�S
__. _.Oare_ . _
- ACTION BY AUDITOR -
Date: