Homestead_Hyneman (6) OF4-.1 HG 10..1/279
>resctibed.By State Board of Tax Commissioners
( CLAIM FOR HCtESTEAD PROPERTY TAX CREDIT FOR YEAR 19_ ,
SEE BACK FOR FILING INSTRUCTIONS
I,410), „4yr,-re,,, -7• /q/2y certify that on the 1st day of
March, 19 , CI, (toe) occupied as our principal place of residence the following described real
property for which a Hanestead Property Tax Credit is hereby being claimed:
I, (We) Downed
pare buying under contract
fl have a .beneficial interest in the taxpayer r
(3
Property Description in L �„3 County �.0 -a-g-,2-n 7,Al- Towns hi P
Taxing District (City, Town, Township) : it) _2
Parcel Number f or legal desorption shown on tax statement:
. /2 -/ -/ + , / -
If buying on contract: Owners name (fee side owner) lke_
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
immediately surrounds that structure is used to produce inane, 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 : 'Ibwnshio
I hereby certify the above statement is true, correct and complete. - •
*Signature Street Address 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 improvements (1) \I-Th 7)0 � - / 70
Other Land (2) :,y
Total Land (3) DSO !9 J// -7 � 14,
Residential Improvements Dwelling (4) .36 ,/6115 /// ������
Garage (5) ff4 /-
Total Total (6) 3& /0-0 / ,R 03n / 2030
Other improvements (7) /�/////////�
a
To Improve eats - Line (6) plus (7) equals (8) (8) , to//9-n / a /l 3 O At/
/////U///////
I Way certify the above is true, correct, and oatmlete. • -
1 �/o L-,1 . ifa Date
Signature of Assessor -
- ACTION BY AUDITDR - .
Date:
S I A M TR! 3 TtTE/W}wl tRFASURE IC SIA
APRRIwm BY ST Rt1 aIMROM'MT(R:.'t 'aM rnrrbm BY fir nFMRnc4TILt(R'AE rSK[LYMEh'r FINANCE w.i.t-r-,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 become_
_ more beneficial.there is more incentive than ever for homestead fraud Homestead fraud causes higher ta'bills for all:therefore.
• FIFA 13-14-2009 requires taxpayers who receive the homestead standard deduction to verity that they are eligible to reecene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This information will he kept confidential and can only be accessed by authorized county officials.The Depanmenr of
Local Government Finance will use this information to create toils that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Hyneman, Bret D/Judith
6370 N SR 65
Ilazleton IN 47640
730
Bret D/Judith Hyneman
6370 N SR 65 State Parcel Number Legal Description
Hazleton IN 47640
26-05-12-100-00(1345-017 009-00345-00 PT N 12-1-10 2 AC
\/ C-1
�\
PART 2:TAXPAYER INFORMATION
Owner II First Middle last
I y'L� �` _ he racy,
0lgAn !n
dressumber Intl street City,state,anti LrY code) me property address
Spouse First Middle Last
�.LQ ;+ �. L• Ny he-mvp-\_
Mailing Address(Number and street-city,state,and ZIP code) [%&me as property address
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 properly. 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
•