Homestead_Folsom FORM HC 10 1979 To Be Filed in Duplicate
Prescribed By Slate Board of Tax Commissioners
• CLAIM FOR HOMESTEAD PROPERTY TAX:-CREDIT FOR YEAR 19 7f
\ SEE BACK FOR FILING INSTRUCTIONS
8� �1, �d e
®(We) $ certify that on the 1st day of
March, 19 I, (We) occupied as our principal p ce 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 in the taxpayer •
Property Description in a e-y County hahn—,4-) Township
Taxing District (City, Town, Township):
Parcel Number or legal description shown on tax. statement:
Op. if Kt a-3-9 /. 95"8 _,2J
If buying on contract: Owners name (fee 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
Any other counties in which individual owns or is buying real property: County Township
•
'hereby certify the above statement is true, correct and complete.
4/A ,,'/ olaier� /Pat4Do /63 C • Ca �r�,� �'
'5' nature Street Address City, State ip Cod
5e7 CO
' 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 exceeding 1 (one) acre immediately - /70
surronding Otheru ialImp
Land rest r me ;.i (2) 3 f r9
Total Land ,o (3) 180 _- _. 0
Residential Improvements ' _ 1,79 (4) _4?r/-B_
Dwelling //a/a��o/ ///%/%
���21 Garage (5) --�no � / %I./° - /
42/1 Total •(6) -- 0_
Other Improvements
AUDITOR (�) e3-�o SO _ o ---
Improviments Line
ne (6)iplus (7)correct.equals (8)
complete. (8) / °-
Signature of Assessor -- —"V -/ � Date C 77
- ACTION BY AUDITOR -
oi? 9 Date: s' &/ —/ 9 Approved: —rj
MATE FORM 3t IK 1•ul TRFw511lER FOAM:S-IA
ApMNEOOY SATE MARDrwnrt[liNS._uv Plr9Nn[nnY THE DEPARTMENT OF LO;ALQNErNMEnn FINANCE MH.14:J.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PFINCETON 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 loud.(homestead fraud causes higher tax bills for all:therefore.
•- HEA 1344-2000 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to teethe the
benefit and to provide additional identifying information necessary ro allow county government to better monitor homestead
tiling.this information will he kepi confidential and ran only be accessed by autharimd county officials.Thr Ikpanntenl 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 Prnpertv Address
Folsom, Charles D
5217 S State Road 57
Oakland City IN 47660
3204
Charles D Folsom
5217 S State Road 57
Oakland City IN 47660-8564 State Parcel Number Legal Description
I rlullntlt11ur11u11ur1n1n1t1n��ntiu 1ut111nt1t11r r1 26-20-02-401-000.088-003 020-00088-00 PT SE 2-3-91.758 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 i Last
C H /� b e k2a y/7 P /- v/ S D.7k7
loang Address(number and street.city,state,and ZIP code) 1, Same as property address
5177 S. S"P � 7 C/+KL//Nb C iiy //V 976L( O
Spouse First Middle Last
riX7
-
Mailing Address(Number and street,city,state,and ZIP code) Same as properly address
Social Security Number(Last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
Soo
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 IISo�� !9 //,,__"' Date
•
Spouse Signature , Date Telephone
PART 4:ADDITIONAL INFORMATION