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Homestead_Hartley FORM HC 10 1979 To Be Filed in Duplicate Prescribed By State Board of Tax Commissioners CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19_7L SEE BACK FOFt FILING INSTRUCTIONS (We) 't g' ✓Q �1 �IC. Ctkt �—certify that on the 1st day of arch, 19 7�, I, (We) occupied as our principal ace of residence the (lowing described real property for which a Homestead Property Tax Credit is hereby being claimed: • I, (We) ❑ owned ❑ are buying under contract • ❑ have a beneficial inter tin the taxpayer � � L� , Property Description in I:12 nty dc( Township Taxing District (City, Town, Township): _CA-C 4nfa 1 • - Parcel Number n or legal description shown on tax statement: 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. J.. /_—a A - —%/ // - __.1��, id, . .:,. dig- ' ignature Street •caress - City. State and Zip Code 976 13 • !' 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 surrounding residential improvements (1) /90 60 60 Other Land io (2) —0— — O -- Total Land t (3) /go !00 Residential Improvenit Dwelling (4) SUN b.1,919 ttttt'6'� / YS Garage (5) O— Other Improvements 1 /42.d/total (y) —O — —0— T Improve gents - ti( true. (orrect and�omplete. (8) � CL-0161 x= 7'9 - Signature of Assessor Daze Q - ACTION BY AUDITOR - Approved: ! 1 .A-i�'c Date: 6' y 7 f • [lAt£FORM W Ilrr)+P i TREASURER r(MV"MIA • APPROVED BY'TATE Bn■RDOE Artrrxn.cn+ PIIYAI&RI BY flit DEPAREVEVr rr Le AE GOVER,VVR,'r FINANCE MV1.13:a.1.1 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. 6 HEA 1344--2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recebe 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 ace:,ed 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. I PART 1: PROPERTY INFORMATION Taxpayer Name Property Address Hartley, Robert W/Beverly Kay 611 LINCOLN 3198 Robert W/Beverly Kay Hartley PO Box 321 Somerville IN 47683-0321 State Parcel Number Legal Description Inl ��rtt�t�itt�r t�r rt�it�� ��rtt�t�trt��t t�t�rr t��nr��r� 26-20-02-22044-000.140-003 020-00140-00 MOORES ADD 12 rr . — — — — — _ _ _ _ _ _/ . __ _ - . 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 1 First' Middle Last To AER_L 17,freez y Itg Address(number and street,ncity,state,and ZIP code) / ® Same as property address // �.I4ea/d l °BO( 321 o�O4I C i'nLi'e T4/• "7/ 3 Middle - Last Lsaeg(1 try Ale/LEN/ Mailing Address(Number and street,city,state,and ZIP code) © Same as property address lv/// 6/1/00 7/1/ 1/42:KV 32-6 &oM)e`leo,CL6, XV Aill3 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. O •ia g tee ow / Date 4 PART 4:ADDITIONAL INFORMATION •