Homestead_Willis (4) FORM HC 10 1979 . To Be Fled in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTA TAX CREDIT FOR YEAR 19 77
/� SEE BACK FOR FILING INSTRUCTIONS
e) /-�'-tt-c� /C - )4 wzs-s _n-a-- —ertify that on the 1st day of
arch, 19_9, I, (We) occupied as our principal pl a 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 est in the taxpayer
Property /
Property Description in 'a' "
O `_ C., my 812.4- 0-14-2 Township
Taxing District (City, Town, Township):
Parcel Number or legal description shown on tax statement:
Safr-11-1-±t2) Mice. /e %i7
If buying on contract: Owners name (tee simple owner) Zo/z/
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
ereby certify the above statement is true, correct and complete.
7/0 s
'Signature St;•-I•d.ress Base City, State and Zip Code
//f
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 imme..,,r�lte
surrounding residentfim over lints 1. (1) . a O No O
Other Land ` 1",, (2) —`.�,0 — �--$Oa•
Total Land (3) T° /
Residential Improvements i;ifaY 1 1979_ (4)
�j /���/i�2<�" aedyeg (5) —OS9a D Ajjj✓4:,
�%j�j�
f/l r (6) -41---e-r) _ �+ Cy i
AUDITOR Total - � ��
Other Improvements - (7) AC//b g ��j
Te ;provements - Line (6) plus (7) equals (8) - (8) / U d o
- I Iiy`cer f the above is t e. correct. and complete.
0----r-4/ - 4=s= 79
Signature of Ass r Date
�Q - ACTION BY AUDITOR - r ^Jq
Approved: !/1 • 9 . --�r.) Date: `� M -/ /
VT ATE tORY 51w,Re/YWI IAL4SULEA FORM SIA
• .APPV n'EO BY'CUM IXNYO DE NM1RI\T1.11v PESYR1&W BY Mr nrPARTNEYT OF LOCAL rlwftNMLTT MIAANCE M 11-I.1r-AI
Gibson N Main County Auditor
'101 N 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 net for homestead fraud.Ilomestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligiNe to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
tilint_vn,this information will he Lery confidential and can only he accessed by authorized county officials.The Ikpanateal 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
Willis, Dennis R/Deborah Joanne
5132 S Lincoln St
Somerville IN 47683
8441
Dennis R/Deborah Joanne Willis
P 0 Box 346
Somerville IN 47683-0346 State Parcel Number Legal Description
Itltrilttrltnttlrllllllllll IIIIIIIItllltlltt'tllttltl,tl 26-20-02-401-000.292-003 020-00292-00BARRETT ADD 16/17
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
Yl A ) /// S
le Address(number and street,city,state.and ZIP code) ----- —❑Same as propeM adi3ms; -- — — -- --
-o.hox3 (6 _5'13,)• %. kola'obi Sam ac /f/e , fin . '1 -7(ot 3
Spouse First Middle Last
1)42-6/Na h to a4n (.v l 1/15
Mailing Address(Number and street.city,state,and ZIP code) ❑ Same as property address
6„80k 6/3a- ,8, 1-/nko/n s1: SOinell y?& i
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
unlawfitlly,he or she may be liable for back taxes and substantial financial penalties.
Owner I g ature Date
PART 4:ADDITIONAL INFORMATION