HomeMy WebLinkAboutHomestead_Clem FORM HC 10 1979 le-,n �
.1 To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 19
q�_ SEE BACK FOR FILING INSTRUCTIONS
'(We) :14c2A�n �— • le certify that on the 1st day of
arch, 19_74_, I, (We) occupied as our principal place f residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) reowned
❑ are buying under contract
❑ have a beneficial int rest in the taxpayer .
i
Property Description in �/ a—�%�J County Township
Taxing District (City, Town, Township): UY
Parcel Number or legal de cription shown on tax statement:
- 1t Ai ?1wY4 Z/- /- 9 4oa
If buying on contract: Owners name (lee simple owned
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. -
Sig ure ��„., . J '� Si �itt.t.State Damn 4 . �1t°�y
'Signature �f Street Address city. Stare and Zit code
* 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) 40-o /?'D /70
Other Land (2) 7 7 t a 3o g v
Total Land FILED (3) 773 0 - - . a ,-,"9D
Residential Improvements JUN 1 D (4) £2. 0 ���������
Garage �jjjjjjjjj %�///SI
otal (6) g� a O ins _e
Other Improvements AUDITOR (7) 35"3 0 . '�
Tc' Improvements - Line (6) plus (7) equals (8) (8) 1 7 Co a29 z O
IPby certify a above is 'tr . correct. and complete. 441117D•
J u e //- 77
Signature of Assessor Dare
- ACTION BY AUDITOR -
•
Approved: %29 4—Ze) Date: 6 /9 79
star£rnnnt!x W 12-r WO IAFAAItIA FOAM TS IA
APPROVED arsrOF.WARD Of ACIMUKTS._,N runlam BY 711f oFrAanW:VrrftntLrovttANMrn'T FINANCE K41.1-_AI
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead asandanl deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than exec for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
-_ . _HEA 1344--2009 requires taxpayers who receive the homestead standard deduction to verify that they arc eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This inhumation will he Lepl confidential and can only he accessed 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.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Clem, Rosemary
H I Box 89
Francisco IN 47649 Q b1
1145 1 ki,6°
Rosemary Clem
R1 Box 89 State Parcel Number Leal Description
Francisco IN 47649-9258
111ollntitiintin11t1n1t1tu111111t1t1• 1l1n1t11utiniri 26-06-21-100-000.098-017 009-00098-00 SE NW 21-1-940 AC
C-1
y
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
rg Address(number and' city,state,and ZIP code) El Same as property address - - -.•7 10 e, D D it1, ��t airu� e C-0 r f7e J
Spouse First Middle Last
Mai line Address(Number and street,city,state,and ZIP code) Same as property address
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