Homestead_Dersch MATE FORM!)M+I It:tw&, 17tEAA:IEn FORM 3-IA
A•PW/:ED BY STATE BOARD Or RIMINfl.1w* PIESTmm BY 111E DEPARTMENT OF L(RAL raw-taMrxT FDitsrE IC 6-1 l-r41
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples arc limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than eser for homestead fraud.Homestead fraud causes higher in bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verily that they are elicit*to receve the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing..This information will he kepi confidential and ran only he accessed by authorized county officials.The Department 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
_ Dersch, John T/Mary Lou
•• ��
— - — - - R I Box 217
Oakland City IN 47660
4725 -- - 52 - - - - - - - - - - - -
S
John T/Mary Lou Dersch
— State Parcel Number Legal Description
Oakland City IN 47660-8428
It Ittllttrltllt ttlltt llatr ltt ltrltr lrl lr lltrl err 111 trlrll lrr rl 26-13-24-300-000.243-006 00300243-00 PT SW SW 24-L-91.01 AC
D-6 C-1
PART 2:TAXPAYER INFORMATION
Owner I First Last
: i • D - r h
fig Address(number and street,city,state,and ZIP code) --- I II S¢rne as property address --- -- - - " -
. a S7 a 57 Cot Sar if / zr 'e7 2 O
Spouse First Middle Last
�(ary !-,oar Itrich
r,, Mailing A dress(Number and street,city,state.and'LIP code) ILI_Same as property address
a y3,2 5 S-r ?D 57 DO1lbrvit iii t# 7tzio
PART 3:CERTIFICATION
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is taste 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 MC 10 1979
P[mrined By State Board of tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19-17--
To Be Film in D uplicate
V
SEE BACK FOR FILING INSTRUCTIONS D
003' OOa,�i3'0
1(We) la -7 � J. 4- certify that on the 1st day of
march, 19�, I, (We) occupied as our princ' al place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (Wexowned
❑ are buying under contract
❑ have a beneficial in res�t��in the taxpayer
Property Property Description in ;677 —e-n�
Taxing District (City, Town, Township): d
Parcel Number
If buying on contract: Owners name 11" snnoie owneq
Township
or legal description shown on tax statement:
P-4- , J % h)% �V --� -9 /, O/
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: County Township
I hereby certify the above statement is true, correct and complete.
ignature Street to'.. City, Slal an Zio Cone
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 q E D
Total Land l�
Residential Improvements jv,:I 2 s 1 79 Dwelling
Garage
I
Other Improvements �� AUDITOR
Tnt ,il Improvements - Line (6) plus (7) equals (8)
',oby certify the aboy6) is true. correct. end complete.
S".:.,o 01 Assessor
- ACTION BY A
Approved
True Cash
Value
(1) Z—"
(2) 161
(3) 15"10
(a) SSo
(5)
i
-
Assessed Homestead
Valuation Valuation
Date
Date: (!Lr 26