Homestead_Ray STATE TORSI SliM(RI/&10) TREASURER EO0.wl$IA
APPROVED BI STATE BOARD OF sCcOUNrS.NOR PRESCRIBE BY TIE DEPARTMEIT OF LOCAL GOVERNMENT FINA`ILF.IC 6-I.I-124.1
- Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N.Main Street Individuals and married couples are limited to one homestead standard deduction.As the receipt of this'deduciion'becomes
Pflnceton, IN 47670 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 to receive the homestead standard deduction to verify that they are eligible to receive the
0' = 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 be accessed by authorized county officials.The Deparm eot of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION -
Taxpayer Name Location Address
' ,. Ray. Charles D/Claudia L .
619 S Main
_ Princeton IN 47670
2983 .
Charles D/Claudia L Ray till iiL_ ii illti Bill ii_ ti BIIII�Ii I I lIIDII_11,1111111 III. IIIBillii]011 till
619 S Main
Princeton IN 47670-2447
1111111111111111111111111111111111111111"111111111t11111111111 t'llllll'IIIF State Parcel Number Legal Description
F'ri(3r4D60-020OUTHWARK ADD 8 PT
APR 2520111
This form MUST be retuFe �1' m-county A►uditor'soffice. ,
Please do NOT send this form back with your tax payment to the county treasurer.
— ,. -----" -- .
Spouse First Middle
C it-ut.a Lynr Ray
D
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
613 S. M a.In 5f. Pr ,. necfonrg.. 417670 ,
.
• - 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.
•
FOf7M HL IO 1979
hescriGeO By S�ate Boa�E ot ia. Commissioners
io Be FileO in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�2 �
SEE BACK FOR FILING INSTRUCTIONS o�g_ oaaeo-oo
�(We)��--
as our principal place of re dence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) {�I owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description i
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name �'� ��mo1e owner)
� Township
or legal description shown on tax statement:
� �. .
. .
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:
�- hereby certify the above statement is true, correct and complete.
���. /._ � ✓%.. . i �I 9 5 m_�
County Township
anG
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 Improvementsil�N � g �979
(�)
(2)
(3)
Dwelling �°�
Garage
� ��/���� Total
��i ,�
Other Improvements qUD�TOR
T���Improvements - Line (6) plus (7) equals (8)
I._ �by certify ihe above is true. correcl. and complete.
Signawre
(s)
(6)
(�)
(8)
True Cash Assessed Homestead
Value Valuation Valuation
•!.
ACTION BY AUDITOR -
�o- 10 -iS
on:e
Date: �L1 h_L�
/ ! "