Homestead_Cleveland FORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners r— , e' ,
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 79
SEE BACK FOR FILING INSTRUCTIONS
(We) V- 1-1-6-14L) INf-e2 /L4t cA
certify that on the 1st day of
arch, 19_0, 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 int sl in the taxpayer /y��",
Property Description in t-0�'� County �'✓ Township
Taxing District (City, Town, Township): v r' GL�J
Parcel Number or legal desc ption shown on tax statement: / L 4_
192Z . ?1.f% 9?t%/ /9-/- 9 '--.-7- &to
If buying on contract: Owners name (lee simple owner)
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• 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 stat ent is true, correct and complete.
•' t 7 -1. r t% >� h-//-71
'Signature Street Address City. State and Zip Cooe
' 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 -
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True Cash Assessed Homestead
Value - Valuation Valuation
Land not exceeding 1 (one) acre immediately
surrounding residential improvements (1) .571,--0 /10 / 0
Other Land (2) , la O v2-A-5 j/te_ , ..,, ./�%��
Total Land Fl L E r$1 (3) // !a 0 - ii
Residential Improvements a
Dwelling
JUN 1 2 1979 (4) 5�9b � jjj�
Garage (5) -C — _ • �j�/-
Total (6) 5/9a ..1`f '
Other Improvement /� (7) /-0 — ''—',0�//_
T Improvements - L ne (6) plus f J1� UT8ks (8) (8) '�`9. Q_ v
hry certify the abo is true.f correc and complete.
0._.c.4.- tea) .5--//— 79
Signature of Assessor %/ --re- Date-
- ACTION BY AUDITOR -
Approved: :_ • I - C_ Date: —1 - /_2 -2?
tr(TE 1 nn.M 535If I R-1 Sias) TALSUUUA FORM 73-1A
11TRO En BYcl UT KARD M.M totI\TS_!WM PRESCRIBED BY I11r DEPARTMENT!"L(AALrOVERYMF.T rDasctMVI.1r4.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 ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore.
• HEA 1344-7009 requires taxpayers who receive the homestead standard deduction to verify that they are elicible to recene the
benefit and to provide additional identifying information neces ry to allow county government to better monitor homestead
filing.This information will he Lept confidential and can only be accessed by authorized county officials.The Depanment of
Local Goverment Finance will we this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
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Taxpayer Name Property Address
Cleveland, Melvin/Sedolia
6413 11 450 N
Francisco IN 47649
1079
Melvin/Sedolia Cleveland
6413 E 450 N State Parcel Number Legal Description
Francisco IN 47649-9236
II ' II ' III I I I I II I I II I I II I 26-06-19-200-000.101-017 009-00101-00 PT NE NE 19-1-9 18 AC
to for utu ru tuntu n n u e Y C-1
PART 2:TAXPAYER INFORMATION
(honer 1 First Middle Last
SSea 0t RlJ�11 1 e VC/ 'a-?Na
nn Address(number an a street,city,state,and ZIP coder — - - -
6`ii.3 E. 90 N F'€4Naisca Til f, (19 — 923b
Spouse First Middle Last
Melvih - deceo od
Mailing Address(Number and street,city,state,and'LIP code) ❑ Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
slay
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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