Homestead_Kelley (8) STATE FORM!OW,R/f-ai T R E A 9 n R E A m o t r5-tA
A AFFRtI.ED m'STATE N1 Oni"MA L1S._aM PRIYTIOCD BY TIE orPARTNENO(IF LOCAL cOv2RNnrnn FINANCE K' it-U'-rl
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 escr for homestead fraud.homestead Irma]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 receive a the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.-Ibis information will he kept confidential and can only he accessed by awhnrind county officials.The Department of
Local Government Finance will use this information to create mils that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Kelley, Dennis M/Kathy R
314 F Glendale ST
Princeton IN 47670
•
2384
Dennis M/Kathy R Kelley
314 E Glendale ST State Parcel Number Legal Description
Princeton IN 47670-1643
IFIuIIFUItilnlutill IlFllFFFiululluuiltlnllI Dll 26-12-06-403-001.444-028 019-01444-00 WARNOCK 32 PT/35
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Den I� Ke1 (ey
gAddre .(_umbcndscztecit' stt maw ZIP code - - .. _ gSerne a=P._perty rvcLcs
Spouse First Middle f Last
hlafh y R & ► (e`f
Mailing Address(Number and street,city,state,and ZIP code) ® Same as property address
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is we 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
fOflM HC 70 19i9
Pre5cri0e0 By Slate Boa�G af la. Commissioners
To Be FileG in Uuplica�e
CLAIM FOR HOMESTEAU PROPERTY TAX CREDIT FOR YEAR 19?� ,/
SEE BACK FOR FILING INSTRUCTIONS Q�Q – o�Y�I�I' A�
(� �we> dl-e���» : �-`���, ,� /2, �.-�C.e�
March, 19_7�, I, (We) occupied as our principal r�ce of residence the fo
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial intere,�t in the taxpayer
Property Description
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners
ify that on the 1st day of
described real property for
Township
or te�4 ,al description shown on iax statement:
�'VCLLi (.(.d.d. `3��i��" .
Contract recorded in Recorders Office - Record N
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, correct and complete
County Township
' 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 -
True Cash Assessed
Value Valuation
Land not exceeding 1(one) acre immediately
surrounding residential improvements (�) % �%O
Other Land
Total Land
Residential Improvements
Other Improvements
T� Improvemenls - Line (6) plus
I �. �eby certify the above is true.
Sigwwre oi Asxssor
Approved
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Homestead
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