Homestead_FergusonCLAIM FOR HOMESTEAD PROPERTY TAX PoRM
CREDIT /STANDARD DEDUCTION HCto O1
Soda roan 5473 (R71 S.M
Presoribed by the Deparbriant of Local Covernrrent l'inanoe
INSTRUCT70NS See reverse side for Nmg instructions.
I (We) �,, a A A AJA ) \�YV m* d5tcdf ffT ly J" March, 20
I (We) occupied as our principal *qoi residence the following cl�ej�hmdreal pwtop!n&=r=ty for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Are buying under contract -?/7'
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the Uggappontract-
Glmwe3��
CONTRACTRECORDED,k%
ff buying on axis Fee Simple ownees name
Recurdeft oflice where contract is recorded Record number Page
- � ..I,,-,, --l" , .. m . .:PfiWERTYoitmEb:aycLAwANTiN.rbTHERcouwiiEs.:,
County
Township
County
Township
I hereby car* the above staternents are true, correct and complete.
Township
(nanber e`7 0:7
10A A7 7
Taoing district (cify. tons,
$
Valuation or s35'000
she
Land not exceeding I (one) acre i mmechately
Legal d2mm-
— 7 —07—
proper-tz . 0
urroundirg residential improvernents.
AR
❑ Motile Hot. (I.C. 61.1-7)
ll airy potion of the residential struoix" or the land rKA exceeding one (1) acre that mme68idy dmvxKkB Mat structhae le used m prodca Fhoma, describe the use and portion
dthe property LAffo9d In produce ir.,
Other land
- � ..I,,-,, --l" , .. m . .:PfiWERTYoitmEb:aycLAwANTiN.rbTHERcouwiiEs.:,
County
Township
County
Township
I hereby car* the above staternents are true, correct and complete.
t
(nanber e`7 0:7
10A A7 7
�1
ASSESSOR USE ONLY.
TFiUE:TAi
•
l4dKiiiiIAD
-1r'
NON 4MSMENnAL A,
Lesser of 12 Hornestead
t
d
-AT1 8W%'FTry _
�1
$
Valuation or s35'000
she
Land not exceeding I (one) acre i mmechately
crate
— 7 —07—
urroundirg residential improvernents.
AR
Other land
(2)
Iced land (fare 1 phis (em 2)
(3)
Dwefli ng
ResidentialffnproveiaentsmAnnually
(4)
Assessed Mobile I Mmxr%ctmBd Horne
Garage
(6)
AM
AP
Other improvements
W
Total unpravernents (&?e 4 through fine 6)
Total value (line 3 p1m Em 7)
(8)
I hereby car* the above is true, correct. and
co"Wlete.
Svvh" of ft err
Mft SVmd
%ftT " amen - Signehom of Auditor
Data signed
'STANDARD DEDUCTKWALLOVWMCE,r
'' F,"�
20_ Pay 2O_
Lesser of 12 Hornestead
$
Valuation or s35'000
she
crate
— 7 —07—
S1ME rmunne.lR twit t}FA41[EI FORM 3.a
l
AreRtWt t*En BY Ct'tE'MAD Of ACCOUNTS nw RIYAIBED BY ME BEPARMEYi(W LOCAL GOVCANNITNT MA\'CE IC 4-1.1-2:4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 IndividuaLs and married couples are limited to one homesead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than e'er for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2000 requires taxpayers who receive 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 be kept confidential and can only he 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 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Ferguson, Jacob
10884th ST
Francisco IN 47649
1737
Jacob Ferguson
106 N 4th
FRANCISCO IN 47649 State Parcel Number Legal Description
26-13-19-202-000.199-005/ 012-00199-00 OLD PLAN 19PT
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
Owner I __ First Middle Last
7
•lg Address number and street,city,state,and ZIP code) ❑ Same as property address
- a Box as/ a,0 /Sr0 . z7 76(79
•
Spouse First Middle Last
Mailing Address(Number and street,city,state.and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
, PART 3:CERTIFICATION
Each undersigned certifies,under penalty of perjury.that the above and foregoing infonnation is true and correct and that he or she is eliuible 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 •. - Date
( )
PART 4:ADDITIONAL INFORMATION
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