Homestead_Willis (5) FORM HC 10 1979 To Be Filed in Duplicate
• Prescribed By State Board of 7a. Commissioners
•
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAW119u9
SEE BACK FOR FILING� TR
INSTRUCTIONS
Q �6 /
1We) • 6 . II 21 • 9 ✓ is --(C ia- certify that on the 1st day of
iv arch, 19 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) N owned
Scare buying under contract
0 have a beneficial int Jest in the taxpayer. •
Property Description in -4.---1-0---6-14--.) County e Township
Taxing District (City, Town, Township):
Parcel Number or legal description shown on tax statement:
at. �iy� a2-3- 9 te.a9aasal
If buying on contract: Owners name flee 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
ereby certify a above statement is true, correct and complete.
¢ 6A
4S m. e�< q. �9R.j tiox /bpi Ci QakLAilo £/t .4/ . 7
Signature trees Address City. ate and Zip Code
T a-t, C., 19 79
C/ • 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 �7 0
surrounding residential improvements (1) /�'O Dr'a o
Other Land (2) _ LSD .0,-.97 1 O
Total Land' (3) ci----3 0 /.4-tr $D
Residential Improvements (4)
�
JUN G 1979 � /
Garage (5) a ig� %/%i //�j�/j
/
Other Improvementa r'
AUDITOR Total (6) / s �
/ _ 9,a
(7) _ °G°
T mprovements - L i e 6 p lus ( equals (8) (8) —/ _TttL
roy"
certif the above is tr . correct. and complete. a Sa 0 8 'C ?0
St6-- 79
Signature of As Date
�- ACTION BY AUDITOR -
Approved: /r2-_,P... / 2k c Date: 47lo _.9
STATE foul`) IR_ .-oit tRE,s:rIRMFC IAA
.APPRIT'ED BYSTATEBOARDMAITTR4NTS.:Ma PRr3A1aQI BY TIE DEPARTMENTOF ILAAL CM[0.YMEKTMANCEICLI.I-E_4.1
Gibson County Auditor
101 N Mart 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 incentixe than ever 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 recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This inforrnation will he kepi confidanial and can only he acrossed by authorized county officials.The tkpanment 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, Kenneth E/Elsie M Life Est Etal !NE--
RI13ox163B
Oakland City IN 47660
720
Kenneth E Willis
5088 S SR 57 State Parcel Number Leal Description
OAKLAND CITY IN 47660
26-20-02-401-000.296-003 020-00296-00 PT SE 2-3-9 5.09 AC
X
PART 2: TAXPAYER INFORMATION
Own/er/I First Middle Last
�AJeurri-/ ft. 6ch./e wILLiS Si?
Og-A-ddriss(number and rude[,city:state,aiidZlP code) ' -- -— — - - -® Sarre as property uddrxss - -- - - - -
'Cc(9 8 S- sr4se R , S1 , OA).1LA.�n Sri L/ s,v 4!�/ to 6 0
Spouse First Middle Last
FISH Mn t k/ LL) S
Mailing Address(Number and street,city,state,and ZIP code) Z.Same as property address
SO0(13 5..Sra rl Rn, S'I 0 4/1J n 'JO colt &J 4 144 0
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
/I PART 4:ADDITIONAL INFORMATION