Homestead_Doerner (2) FORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners i
CLAIM FOR HOMESTEAD PROPERT-y;TAX CREDIT FOR YEAR 19 / 7
nnSEE BACK FOR FILING INSTRUCTIONS
We) jA2-cei.L.-e_ c2—r 24 ,224A -L� �"-'�-�h9� certify that on the 1st day of
arch, 19 79, 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 intere t in the taxpayer
Property Description in _,A_-t-a--rr-_' County Township •
Taxing District (City, Town, Township): •
Parcel Number or legal description shown on tax statement:
Imp,- //t-/t±/
If buying on contract: Owners name )tee simple 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
a
Any other counties in which individual owns or is buying real property: County Township
hereby certify the above statement is true, correct and complete.
t t � S. yiv8�
g ae
Street Address / City. State and Zip 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 -
True Cash Assessed Homestead
Value Valuation Valuation
Land not excee pg 1 gone) re Emee y �/
surrounding residential improvement (1) X0,2 0 ° / . •` o
Other Land J UN 1 3 1979
(2) —0 — — O j�—
Total •
j
Residential Imp a
fy
AUDlTo Dwelling
Garage (4)
(5) 2720
— 3890
Total (6) 4/0 -97-0—
Other Improvements (7) _o
Tr Improvements - Line (6) plus (7) equals (8) (8) 0 5���
-I by certify th bove is true. co ect. and complete.
_, 7.Q/
Signature of Assessor Date _d 77
ACTION BY AUDITOR -
Approved: 6\ - 4`0� P. Date: 9`.5/71
•
I
' IATE FORM`!'.1t_J54P1 1REASIatR EOM(—IA
Arrsra-co BY STATE BOARD Of A(Ttt:\TS.1.v PRr.%AIBm BY TM DTP. ThV4T(WLOCAL GOVERMENT FINANCE IC•1.1-r.s.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple:are limited to one homestead aandanl deduction.As the receipt or this deduction becomes
r-- more beneficial,there is more incentive than eter for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
HEA 1344-200g requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receve the
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 Department of
Local Goverment Finance is ill use this information to create tools that will help count'officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Doerner, Freddie C/ Marcia F
Box 262
Somerville IN 47683
8469
Freddie C/Marcia F Doerner •
Box 262 State-Parcel-Number Legal Description -- - ---_-^
-- - ----c-Somerville IN-47683:0262--- --- "` '--
IILPIIrIrLIIrtLlLttllllltrrtrl tltllttttlJtllttttltLLlll 26-20-02-404-000.061-003 020-00061-00 OLD PLAN 11
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
redeliie _ C Iare,ice_ De el- 7e-r
ill,ng Address(number and street,city,state,and ZIP code) Some as property-address V -
e1626°A26 z Si.,er✓;') !e r� 678 3
•
Spouse First Middle Last
/27/9,aC.X",4 F yE DOL AWr—
Mailing Address(Number and street,city,state,and ZIP code) !Jeanie as property address
oc! %f — --
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
PART 4:ADDITIONAL INFORMATION
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