Homestead_Oursler (3) r: •
shit FOAM•,Ph 1R tNMI 711.E1linn FORM i-IA
APPROVED Byct■tF BARD OF ACTY*LNTS_"on PAFxxmmm BY TIIF nFPArTNlggor L(M:1L GOTTRT'IMTNT FQ:AScE MLI.I_-ni
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead sandanl deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they arc eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kepi contidemial and ran only he accessed by nuthori,ed county officials.The Department of
Local Government Finance will use this information to create outs that will help county officials eliminate homestead fraud.
---PArtint7 PROPERWINFOIRICIATION -
Taxpayer Name Property Address
Oursler, Leonard Jr/Jerry Wayne
110 W Warnock
Princeton IN 47670
2335
Leonard J Oursler Jr
110 W Warnock State Parcel Number Legal Description
PRINCETON IN 47670-1432
II I II I III III I II I i I'll III 26-12-06-304-002.061-028 019-02061-00 CHAS BROWNLEE
t tt tut t tt tut t tt rt rut t rte tuft r t 7PT/10PT/11PT
PART 2:TAXPAYERINFORMATIQN
fauna I First Middle Lass
cotiyv 6ZCRs7IL (37)
it Mdresa(nunfor"asdstrm:,cry;state,and ZIP code) _— - - -- - Same ns propertynddresx. _ _- _
//C %/ lr//WQA/GC A S Z PC/t/e -7 r , KS 70-lf/3
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/Sate ID Number (last 5 digits) Other(please specify in Part 4 below)
sex
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
^- '
FORM HC 10 1979
Preuri�t0 By Srote BmrE oi Tax Commissioner5
To & FileO in Duplicate
CLAIM FOR HOMESTEAD PHOPERTY TAX CREUIT FOR YEAR 19 �9 .�
SEE BACK FOR FILING INSTRUCTIONS p�q - o a o� I- o0
�(We) v��'�� ���'`�'�-� °Y• '� ��-2-- certify that on the 1st day of
arch, 19! I, (We) 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) � owned '
are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in � County �a-�-�w Township
Taxing District (City, ow , Township): �-2c-..1 a Z«
Parcel Number or ,lpegal description shown on tax statement:
. K7s. . �.�c� .. i/ � i �
(1 /oPd-
� Pi ,
If buying Ofl contract: Owners name ��re simvie owner�
Contract recorded in Recorders Office - 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.
�i_ r.-u.v� . (�,;u�,a�Fyt !/01�f1 cG-�er��$
'Siana�ure � Sveet noaress
City. State antl Zip Cme
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 improvements
Other Land � � � � �
Total Land
Residential Improvements � Jn' � j iq�� Dwelling
IY
�,Garage
� /�%i{�. // Total
1 + � '�iC2i�
Other Improvements ��� AUDITOR
Tn�mprovements - Line (6) plus (7) equals (8)
I �y certify the above is true. correct. and complete.
True Cash Assessed Homestead
Value Valuation Valuation
�,� �9� o �Gc
(2)
(3)
�
� 9�0 9 90
(4) t%� �''c�.
(5) ,�
(s) �i`3 3 0
��� ��
�g� `f�3�
Approved
���
j/�j�jjj��
�������
�-�o-��
Da:e
.,
Date: �P- �S =7 9 ti