Homestead_Doerner (4) .rescric- d By State Board Of Tax loucu.ssioners
CLAIM FOR Ha'ESTEAD PROPERTY TAX CREDIT FOR YEAR 19 11
l�EE BACK FOR FIcING" NSTRUCTIONS
I,.
•T ) • ��'ti-^ )�-" r '` /tat certify that on the 1st day of
-'< rch, 19 , I, (Pre) occtmied as our principal Place of"residen the following described rnat
,_arty for which a Homestead Property Tax Credit is hereby being clai+re
i
I, (We) Downed
Dare buying under contract .
0 have a beneficial in = stin the taxpayer
Property Description. in Oft 4 so cCounty Township
Taxing District (City, Tarn, Township) : • o+
Parcel Thither ` • or legal description shown on tax statement:
If buying on contract: Owners nacre (fee single owner)
Contract recorded in P corder's Office - Record No. Page
If any portion of the residential structure or the land, not eceeding one (1) acre that
innaiiately surrom s that structure is used to produce inane, describe the use and portion of
the property utilized to produce income
•
Any other comties in which individual owns or is buying real Property: County 10 ship
I hereby certify the above statement is true, correct and complete. •
"Signature Street Address City, State and Zip Code
*Individual either awns or is buying uner a contract that provides he is to pay the.
prroperty taxes on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
True Cash Assessed iresteed
Value Valuation . Valuation
Lard not exceeding 1 (one) acre immediately •
surrounding residential irrrorove• nts (1) 3 go / a O / O
(2) ADO//%%% I
Total Land (3) MAYA //
Total //�//��
Teal ntial Inprovernents
Dwelling (4) /%// //// /����/�G//�//'�
Garage (5) '/ 'ill, //h1,14/
./0
Total / 0/0//
, Other Improvements (7)To Improvements - Line (6) plus (7) equals (8) (8)
I narehy certify the above is true, correct, and complete.
[ Date
%tun of Assessor
i
- ACTION BY AUDITOR -
Date:
Ay covey"
•
_ STALL FORM OO.IR_rw1 MIASMA FORM i3-IA
APPROVED BY A rATL BOARD OF VYc4sTA.Yuw pRFARrBm BY r11L DEPARWENT rw LOCAL GOVOLNIMFAI FINANCE ICYI.I-U.I
Gibson County Auditor
101 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 eser for homestead fraud.Homestead fraud causes higher tax bills for all;therefore.
BEA 134+2009 requires taxpayers who receive the homestead standard deduction to verify 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 he kept confidential and can only he accessed by authorized county officials.The Ikpannrent of
Local Government Finance o ill use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY LNFORMATION
Taxpayer Name Prnperts Address
Doerner, Kent A/Marilyn Kay
Po Box 309
Somerville IN 47683
8470 _—_ _ _ __ _ _ _ _ __ __ .
Kent A/Marilyn Kay Doerner
Po Box 309 State Parcel Number Legal Description
Somerville IN 47683-0309
111 11tt tldt tlltt t�t�t ttrt��� 26-20-02-404-000.068-003 020-00068-00 PT SE 2-3-9.55 AC
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
11-1.20,4t op-eivra")
g Address(number and street.city.state,and ZIP code) Same as properly address --
5363
Spouse First Middle Last
1N1 anZp r
Mailing Address(Number and street,city,state,and ZIP code) 2_5ame as property address
IW 3°R5-3 43 S , �� �� ) yGe 3
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
PART 4:ADDITIONAL INFORMATION