HomeMy WebLinkAboutHomestead_Khan STATE FORM')NIR:/W,n1 IRGUtita FORM CS-IA
APPROVED BY SEUE BOARD OF AM1ROTS.'Mw PRIYRIBED BY illE DEPART2 Rlr LOCAL COVERNMENr FINANCE MH.1-nil
Gibson County Auditor
101 NMain -
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 trt.antes
more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tat bills for all:therefore.
® HEA I 344-21)09 requires tanpascrs who receise the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kept confidential and can only he accessed by authorized county officials The Depannaent of
Local Government Finance will use this information to create uxds that will help county officials eliminate homestead fraud.
PART 1: PROPERTY L\FORMATION
Taxpayer Name PrDpertV Address
Lyles, Tonya R
603 E Emerson ST
Princeton IN 47670
2797
Tonja R Khan
603E Emerson St State Parcel Number Legal Description
PRINCETON IN 47670-1901
' t I I III I III `III I I I I I I I I III 26-12-07-204-001.672-028 019-01672-00 NS LOT 1 PT R2
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
TnJa. kr k/laAi ( LV /c5)
�g'Addrs3(number and rst,city,sw.t.tnd ZIP coda Same es property address -. -
un3 E . a - -E2so1 S-}-,
Spouse First Middle Last
Mailing Address(Number and street,city.stale,and ZIP code) 0 Same as properly address
Social Security Numb ilasfi.dieit l -Drivers Lieense/State ID Number-(Iasi 5 digis)-- -Other(please specify in Part 4 below)
sme
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
fOFM HC 10 1979
PreunOed 8y Sta�e BoarO at Ta.�Commissioners
io Be FileO in Uuv�icate
CLAIM FOR HOMESTEAO PROPERTY TAX CREUIT FOR YEAR 19�� , ✓
SEE BACK FOR F�ILING INSTRUCT� D(9'— DII07at� �O
�� ( W e ) ��. ��1./`-r�,fiJ�Ci' > �� ! 1 A ...�.
�larch, 19 ,(We) occupied a our principal place o re i en�
which a Homestead Property Tax Credit is hereby being claimed:
certify that on the tst day of
the following described reat property for
I, (We) }'y�owned
�❑ are buying under contract
O have a beneficial in rest in the taxpayer n ��
Property Description in , C.ounty�.,� ,/`--�i�G%u-�GQ . Township
Taxing District (City, Tsaua--7e+v�asFtip): �_�Lt�n.Qfl�i-�
Parcel Number or legal description shown on tax statement:
- � .EJ � � .t" —Z� �
If buying Ofl contract: Owners name ��ee simv�e ow�e0
Contract recorded in Recorders Ofiice - 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: County Township
�hereby certify the above statement is true, correct and complete
�t � � 10�� � ��i
��iqna:ure Screet naaress
Giy, s�aie ana L6 �e
' 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
surrounding residential imp �o em�nts � ��
Other Land � ��
Total Land
Residential Improvements
Other Improvements
, :a
,�,,�.- ,�
.. •J ' .
Dwelling
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'�f—', �Jf To'iaf
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�T•-� Improvements - Line (6) plus (7) equals (8)
by certify the above is true. correct. and complete.
Signalure of Assessor
76'70
True Cash Assessed Homestead
Value Valuation Valuation
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- ACTION BY AUDITOR -
� --� ° —79
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Date: � ' �"�`Zj