Homestead_Lutz (5) SIAM FORM!3rt IR-'Iwo) IAa.vsurAm0.VZt2
ArrRm'Eo BY AVL WOAD OF A-SRW s.an. PAUSCRIBED BY TIE DEPARTS-4T. OF LOALQn20.YMEH}FI:ANCEWSit-r'-RI
Gibson
101 l N IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
N Main
PRINCETON IN 47670 Individuals and married couple.ate limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than eser for homestead fraud.I lomestead fraud causes higher tax bills for all:therefore.
- HEA I344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to teethe the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
7 �' Local Ibis information will be kept confidential and can only h e accessed by authorised comfy officials.The I)epanmmnt of•
11p1L_„�' Luca)Government finance will use this information to create outs that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
APR 7 .111 Taxpayer Name Property Address
_ Lutz, Jack R/Patricia Ann
515 S Main ST
Princeton IN 47670
2§4SON COUNTY AUDITOR
Jack R/Patricia Ann Lutz
515 S Main ST State Parcel Number Legal Description
Princeton IN 47670-2445
26-12-07-304-001.667-028 019-01667-00 SOUTHWARK ADD 5 PT/6
Ithilliellilleiltillil t It It I II I lI It It I nn i l r l t I II Ir Ir I
PT
PART 2:TAXPAYER INFORMATION
O wner I First R Middle [/1 / Last
g ALdri:ss(rrumberanda:x:.ci:;sz :e,-cd ZIP _ _- . - _ _—_. ._u-Same acnmpenynddrra____
c?
First Middle Last
Mailing.Address(Number and street,dl and ZIP code) ❑ Saint as property address
ETV 5 �)D�l 2ix) (� I�,0 — (P7 G 717
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
•
•
FORM HC 10 7979
PrewiDeO By $taie Boa�O o� ia� Commiszioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19��.
SEE BACK FOR FILING INSTRUCTIONS Q(g -
w
To Be Filea in DuDlicate
�
O(lol�?- Ov
.(We) certify that on the 1st day of
�warch, 9 , occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) wned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in��0^-� ^ County �� � Township
Taxing District (Gity, Tluurr,-Toaw�sFt+p): /• ��
Parcel Number
If buying on contract: Owners name ��� simv�e
or le al descripti�ow�on tax statement:
s�� � ��
Contract recorded in Recorders Ofiice - 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: County Township
phereby certify the above statement is true, correct and complete.
� ; � . ; . � ;
G °�' � —
'Sigiumre aaress Gty. S�ate ane Lo�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 -
True Cash
Value
Land not exceeding 1 (on�cr�imm�iatel� �
surrountling residential im ove nts ��„ (� )_� ��o D
Other Land
Total Land
;+.ii�l ? 7 !�i9
Residential Improvements
�//� ng
I/1 .� rage
AUDI�Tp��
Other Improvements
(2) �
�s) � � � o
`� '
�� �
(�) —
T:Improvements- Line (6) plus p) equals (8) (8) �1��
i,...eby certify above is true, correct, and complete. ,
Sigia:ure ot Assessor
- ACTION BY AUDITOR -
Approved
Assessed
Valuation
9so
9r u
Homestead
Valuation
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Da:e
Date: �- %�`- ��