Homestead_Jackson (4) (° : i
San 1124 3 WP '"tin IRSASU@8 FOAM IS-IA
APPROVED BY STATE Wt\ACOF.\t(If NTS._I.N PRESCRIBED m'ell m.r.Ut1ME T Of LOCAL COVER ftLST'MINCE if 41.1-:24.t
Gibson County Auditor EMPORTANT•NOTICE TO HOMESTEAD PROPERTY OWNERS '
101 N. Main Street Individuals and hurried couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial,there is more incentist than ever for homestead fraud.Homestead fraud causes higher tax bills for all:therefor.
HEA 1344-1009 requires taxpayer,who receive the homestead standard deduction to verify that they are eligible to rectihe the
benefit and to provide additional identifying intinrnation necessary to allow county government to better monitor homestead
filings.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 grate tools that will help county officials eliminate homestead fraud.
• PART I: PROPERTY INFORMATION o
II_ E �,�� Taxpayer Name Location Address
Jackson, Ocia A
409 N NINTH ST
OCT 2
32 012V\
PRINCETON IN 47670
351 C � \ I II0IIIImiIII II I III IIIHI CIClIDff� I IIllC IIII o
II .II I Ocia A
409 9thcilBSON COUNTY AUDITOR
Princeton IN 47670-1131
'I11' ' "IIl'III'IIl'IIl1'IlItIIIIIII1Itllll1l1lHI�I'Il�llll State Parcel Number Legal Description
26-11-12-203-001.338-028 BMA 124(125
- - — - — — — ---°e--
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.
. PART 2:TAXPAYER INFORMATION •
.
•
�1 First Middle Last
1-tHfl ( ma\ . 0 P �LS >c >v l S —
f�;t""""x��'.
Mailing Address(number and street.city,stare,and ZIP code) 0 Same as property address "/ n
'/DQ At 94' a� ??x, ne_e\� -I-ly 'x/ 7 (070
Spouse First Middle Last
LU'( 1■ TVe Z U e e_ P&jn e, Z Z
Mailing Address(Number and street.city,start,and ZIP code) ❑ Same s property address
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 fmancial penalties.
Owner I Signature Date
• • • -
�,c mn
ei g CLAIM FOR HOMESTEAD PROPERTY TAX
s:��� CREDITISTANDARD DEDUCTION
.�.;,'� Stare Form Sd73 (R2 / 5-92)
�au
INSTRUCTIONS: See reverse side foi7iling instructions.
FORM YEAR
HC70 �
I e) V e/4 - v�' �^SO^� . c��t� t1�e���March. 19_
�) occupied as our principal place of residence the followin9 described real property.for which a Homest P perty Tax;n��i is hereby claimed:
� 1�
L� i(We) owned ❑ Are buying under contract " ,, NOU .I
❑ Have a beneficial interest in the entity that is liable for ihe property taxes on the property and that owns the property or is�li�ying ur�er �ontrad.
� .
ing on wntract, Fee Simple owner's name
�rtler's oHiCe where Coniract is recorded
e
CONTRACT
PROPERTY DESCRIPTION
County � Township '. Taxing district (ci .own
/ 8-� ' i�-TU ��' � - ,c /
Parcel nu ber Legal deuription
O/� O/33�-��
Fiecord number � � Page
tl any portion ot the residential sirucmre or the land not exceetling one (7) acre that immetliatety surmunds �hat structure is usea ro protluce income, tlescnbe the use and portion
of the property utilized to produce income.
County
OWNED BY CLAIMANT IN OTHER COUNTIES
� certify th abov statem s are true, correct and complete.
�_�� � ��i
(numberarro'sbee dry, sfare, ZlPcode) �
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
� VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediatety .
surrounding residential improvements. (�)
Otherland (Z)
Totalland (line 1 plus line 2� �3)
Dwelling (4) .
Residential improvements
Garage (5) '
Other improvements (6)
Total improvemenis (line 4 fhrough line � (7)
Total value (line 3 p�s line � (g)
I hereby Certify Ihe above is true, torreCt, and SignaNre ot Assessor Date signed
compiete.
Verifying action - Sgnature of Autlitor Date signed
19_Pay19_
Lesser of 1/2 Homestead
ya4a'ation or 52.000
SignaNre
S
ALLOWANCE
�
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