Homestead_Hadley (2) :ORM HC 10 1979 •i'o De /ilea J,n,ilup;.icace
9rescribed-By State Board of Tax Carmissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19_
SEE BACK FOR FILING INSTRUCTIONS
I, • / / „ • n-r.. ) a'-a..-e-1 certify that on the 1st day of
Mural, 19 ' , I, (we)f occupied as our priincioal place of(-residence the following described real
property for which a Homestead Pzo$erty Tax Credit is hereby being claimed:
•
I, (We) p owned •
U are buying under contract
. _ -Q have a beneficial interest.in.the taxpayer x -•
Property Description in County Le.) Taanship
Taxing District (City, Tawn, Township) : / i U .
Parcel /lumber - or legal description shown on tax statement:
If buying on contract: Owners name : (fee simple owner)
Contract recorded in Recorder's Office -..Record No. Page
If any portion of the residential structure or the land, not exceeding one (1) acre that
irrrediately 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 abwnship
. r
I I aby certify the above staterrent is true, correct and Clete •
*Signature : . :.- :;•:Street Address:. •.:: :, �`a ::City,. State and Zip Code
*Individual either owns or is buying uner 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 Hanestead
Value - Valuation ' Valuation
Land not exceeding 1 (one) acre immediately
surrounding residential irrprovatents (1) /7 o l 7O
Other land ._-: 7Y-
o //
Total Land (s) a 7 9 % o
Residential.IrrQrovernents Dwelling (4) ,,/ 2•
4 /
- Garage (5)
T o t a l (6) a a 6 /o Se:-._ 73
Other Improvements (7) - ' A
To i"') Improvements - Line (6) plus (7) equals (8) • (8)
i'. ly certify the above is true,'correct, and oarrplete n
,
Signature of Assessor _ Date •- c: ,`-
- ACTION BY AUDITnR -
"-- ----'- - . Date: -
II km FORM 5Th stir TREASURER rOfl.M Th.IA
r! / AtPMn'fnovsrsm rosxo OF =In, IVSAIPm BS'Tlf ore Rn4tr(i LOCAL tiyMfTT Fe AsCflC 0.1.1-L`-1.1
( 101 Nn Main / IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N Main
1 PRINCETON IN 47670 Individual and married couples are limited to one homesead iandani deduction.As the receipt of this deduction becomes
0 more beneficial.there is more incentive than ncr for homesicad fraud.Homestead fraud causes higher tat bills for all:therefore.
HEA 1344-2009 requires atpa■ers who receive the homestead standard deduction to verify that they are eligible to reecene the
benefit and to provide additional identifvine'infornatwn necessary to allow county government to bitter monitor homestnd
filing.This information will he Lep conflict-teal and can only he accessed by authorized county-officials.The Ikpanment of'
Local Govenunent Finance will use this information to create tools that will help County officials eliminate homestead (mud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address a
Hadley, Fred J III /Krista Jean a874 G Sohn 1 0
Hazleton IN 47640
939
Fred J III/Krista Jean Hadley III
2874 E John Ford Rd State Parcel Number Legal Description
Hazleton IN 47640-9262
II lIrlllrrlrlllrr lll llllrllr itrrrltltilrrlt1l 11rlt1l1rl11dtr� 26-05-57-077-000.272-017 0092002'2-00 PT MD 771108.57 AC
k
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
/�
Ge e' cZ e
c�. . -To e l acI i&(4 —
ticg Address(number and street.city,state,and ZIP code) .Same as properly address -
rn87g E John rot-d Rood Ncz/eJon ZAJ /To /0
Spouse // First Middle / Last
Kris ht Secuel f>< lfgfl
Mailing Address(Number and street,city.state,and ZIP code) ® Same as property address
0,287q E. Sohn Form i?.e uz/e-Jcn _TA) ef7(og0
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
III