HomeMy WebLinkAboutHomestead_DoernerPrescube0 By State Board of tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEARTZ(9-049660 �
OEt. BA TIONS —00
®(We) certify that on the 1st day of
.rch, 19 I, (We) occupied as our principal place of residence the following described real property for
which a Homiststead Property Tax Credit is; hereby being claimed:
I (We) 0 Ho
❑ are' buying under contrast ,
❑ have a beneficial intere¢d -in .the ' taxoaver `
Property Description in — C 'nty Township
Taxing District (City, Town, Township): /
Parcel Number or a descr ption shown on tax, statement:
If buying on contract: Owners name uee aimyle dwneri _•
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:
I hereby certify the above statement is true, correct and complete.
County Township
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re Streat Addr ss 1 _._t _ •.,� � City State and Zip Code
Individual either -Owns or_ivbuying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
iU v 2 lA;d9 FOR ASSESSOR'S USE ONLY -
i ,
AUDITOR U True Cash Assessed Homestead
Value Valuation Valuation
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other Land
— Total Land
Residential Improvements
Dwelling
Garage
Total
Other Improvements
Tot nprovements - Line (6) plus (7) equals (8)
1 li, ..� certify the above is true. correct. and complete.
Signature of Assessor
Approved:
L
(1)
(2)
(3)
2 30o
(4) 3S O O
(5) ;L0 n
(6) —3-151 0''//o0
(7)
(8) 00
- ACTION BY AUDITOR -
Dal.-
Date: D!!
.
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• SlitL[OtM 35 IR-r1Av1 l7CFASI1lf1,FORM 13-IA
.AFPR(wN BY 1111E&MAD nrMrVtIST1.Vry PREYTJBFD BY mF DEPARTMENT IfL(CAL C{KER`IMITT Fa:AycEtw.-p.I--L`JI
Gibson County Auditor
401 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
— more beneficial,there is more incentive than net for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to eerily that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings_This information will be kepi confidential and can only be accessed by authnrired county officials.The I)epanntenl 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
Doemer, Bertha
Po Box 258
Somerville IN 47683
3221
Bertha Doerner
Po Box 258 State Parcel Number Legal Description
Somerville IN 47683-0258
26-20-02-404-000.060-003 020-00060-00 PT SE 2-3-9.76 AC
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
ger7 L I�Aa CY'ACP J Joer e
g Address(number and street city,state,and ZIP code) Same as property address
Ie:bX 258 S6rv)ery;i/e 1-1-76 33
sou
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
sn _
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
Spouse Stgnamre Date Telephone r l
PART 4:ADDITIONAL INFORMATION
•