Homestead_Lewis •
MAILFORSI 53,1.1•2 nap, MASt1AER FORM:STA
.APrKOVEobY VI AILMeRD OF MYYR:.\l_<.••• PUgRIPFD BY 11EDEPART¢.Yr OF LOl'ALCAVtLNsIt T FPA\CE IC4-1.1-U-&l
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to onc homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than excr for homestead fraud I lomestead fmud causes higher tax bills for all:therefore.
HEA 13-1-1-7009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifvme information necessary to allow county government to better monitor homestead
filings.This information will be kept confdential and can only be accessed by authorized county officials.'ITt Depanment of
Local Government Finance xv ill use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Lewis, Charles D/Mary A
2011 Northwestern
Princeton IN 47670
3946
Charles D/Mary A Lewis
2011 Northwestern State Parcel Number Le2a1 Description
Princeton IN 47670-3451
II III I III II I III II it II III 26-12-18-303-001.616-028 019-01616-00 BROADLEIGH PARK
t n tit r nrat 1111ttnn rat tit nr 140-142/150-152
PART 2:TAXPAYER INFORMATION
Owner I First Middle et Last
to Address(number and street,city,state,and ZIP code) f.Same o-property address -
0 I( ikl o r,TE QYriCil
Spouse First Middle Last
>ce g A Iv Iv �A co 2 5
Mailing Address(Num and streeh city,stale,and ZIP code) 11/1 aurae as property address
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
•
FOPM HC 1� 7479 To & FiIM in Oupliwte
ReuriCeO By SWte BoarO of Tax Commis5ioners
CLAIM FOR HOMESTEAD PROPEATY TAX CREDIT FOR YEAR 19 74
�
SEE BACK FOR FILING INSTRUCTIONS Q/n� p/6��� �
� n . �� �
,'(We) �1/1�-Qi,a/ ci�% ��" Q.��1 (h � certify that on the 1st day of
�vrarch, 19—?�, I, (We) occupied as our rincipal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: �
I, (We) C3�bwned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in ��-�1-�^-' County �� Township
Taxing District (City, Town, Township): ��-�/n-r �,.�� �� �
Parcel Number or legal description shown on tax statement:
% �!-o�/'fi�/ S�1
If buying on contract: Owners name �'� simv�e ownep
Contract recorded in Recorders Office - Record
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:
certify the above statement is true, correct and complete.
svee�
County
Township
ana Zip Coae
' 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.
Land not exceedmq 1 �ne) �aCre �etl�[e�y
surrounding resid`ential impr�reme ts �
Other Land
Total Land P1�4;' � � �979
Residential Improvem�nts /�/U��
i,�/� ,
AUDITOR
ASSESSOR'S USE ONLY -
True Cash
Value
(�) .�,30
�2�
(s) �30
Dwelling �4) ��O
Garage (51 ��
Total �6) �
Other Improvements
T Improvements - Line (6) plus (7) equals (8)
I�by certify the above is true. correct. and complete.
Signa.uee
(�) —
�a) /o
- ACTION BY AUDITOR -
Assessed
Valuation
�
� � wB
— :iT
Homestead
Valu ti
e�G
• j�jj�jjjj
- • �����������
Dare
-1/-7
Approved: �- � � �� Date: �: /% 7�'1
.