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r-0wn HC 10 7979 To Be Filed in Doplirate
Prescribed By Stare Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19"L
SEE BACK FOR FILI
certify that on the 1st day of
ving described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) owned
0 6
lJ
/�(O— ',�OIDtO
are buying under contract
13 have a beneficial inteZpt in the taxpayer
L1 Al I
i�
Property Description i
Taxing District (City, Town, Township): yvd
Parcel Number
If buying on contract: Owners name (lee simple owner)
i
Jownship
or legal description
shown
on tax statement:
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
r
,hereby certify the above statement is true, correct and complete.
to
'Signature street Address City. State and Zip Cade
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 -
Land not exceeding 1 (one) acre immediately.
Burro ingiresi ntial r ents
Other and
Total Land cctt
Residential(t�ii%p�oveMerits9 Dwelling
Gard'ge
' Total
Other Im rovements AUDITOR
To' ' Improvements - Line (6) plus (7) equals (8)
I �oy certify the abAe is True. coroct. and complete
Signature of Assessor
True Cash Assessed
Value Valuation
/ACTION BY AUDITOR -
.♦ i
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♦
/ �•
/ - - -
i
Homestead
Valuation
S--//— 7-�
Date
Date: 2L"
HALE UOR.\I!)'MIR_/f-PI
VrWA'EO BY Win.MNRD OFMrt eS.2WM PRISlnnm BY 1111 DEPARINCE4TOF La'AlawtRPMrfl FI: stEMLCI'V.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 tier 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 are eligible to receive the
benefit and to provide additional identifying information necessary to allow county gwemment to better monitor homestead
filing.This inthrmation will he kept confidential and can only M areesse■ 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
Davidson, Geneva F Trust
9369 N Salem Lane
Ilazleton IN 47640
59
Geneva F Davidson
9369 N Salem Lane State Parcel Number Leval Description
Hazleton IN 47640-9314
26-02-24-400-003.066-017 009-03066-00 PT SE FR 24 1 10 1.63 AC
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Geneva Davidson
g.Address(number and street,city,state,and ZIP code) --" Same us property oddra,s - - - -
gsi0t W. Salem Lane ) Hazleton,. N x+764-0
Spouse First. Middle Last
Mailing Address(Number and sine],city.stale,and ZIP code) [J Same as property address
Social Security Number(last 5 digits) Driver's License/Slate ID Number (last 5 digits) Other(please specify in Pan 4 below)
Se
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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