Homestead_McGillem (8) •' STATE FORM!I SiR IS,NI TREASUITA nOkM r3-IA
.VPROVEO BY SLATE BONOnf."Mt../S."IN PEr3(AIBED BY nil DEPARTMENT OF LORE GOVELN1rwT MINCE ICsI.t-r4.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standani deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ncr for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 1343-2009 requires taxpayers who receive the homestead standard deduction to sally that they are eligible to recehe 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 be accessed by authorived county officials.The Depanntent 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
_ McGillem, Jerry Lee/Kathleen
S03 S Race
Princeton IN 47670
1487
Jerry Lee/Kathleen McGillem
803 S Race State Parcel Number Leval Description
Princeton IN 47670-2722 •
Illttlltllllllllltttlll I IlrltltrlrltllPlll 111111111
26-12-18-201-001.965-028 019-01965-00 SS ADD 238/239
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
Je r rq Let /4 e6Attet
on,Address(number and smset,city,state(and ZIP code) Same as property address
803 _, t-e, Sr 2-,'JccYoAi , rA) 1767o
Spouse First Middle Last
11 /eeu /11 e6 ilk M
Mailing Address(Number and street,city,state,and ZIP code) game as property address
Poi S, /lace .57- �/ticcro.v ,--71 A-J
'�
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.
S I Signature �y�I �/ � Date
FOflM HC 10 1979
Hescri�ea By State BoarO at Ta. Commissianers
To Be Filed in Ouolicare
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT FOR YEAR 19�2 ��
SEE BACK FOR FILING INSTRUCTIONS �/ n� O�n��, �
t.J� 7 7
�(We) certify that on the tst day of
larch, 19��, I, (We) occupie our p nci al place of residence the tollowing described real property for
which a Homestead Property Tax Credi is hereby being claimed: ,
I, (We) � owned
❑ are buying under contract
O have a beneficial i erest n the taxpayer
Property Description in� County ���> Township
Taxing District (City, T�'rp): �' ' ��°-•
Parcel Number - or legal description shown on tax statement:
. _ ,�f�� ,�6���3 9
If buying Ofl contract: Owners name ��� simo�e owneq
Contract recorded in Recorders Ofiice - Record No. Paqe
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 oi the property utilized to produce income
Any other counties in which individual owns or is buying real property:
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 ONIY -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
True Cash
Value
n) /oso
Other Lantl (2) —'
Assessed
Valuati � �
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3a—'i�
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Homestead
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Date: _7� �'• 7 9