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•i l.iiflER 53W12i5+n1 1EEOR4:S1A
VIM1nf0 BY‘7411.BOARD Of•YTenT4_nn PRESCRIBED BY n[nEPMMEYfOFLOCAL eAnELMfAl FINANCE
IC 41.1-224.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple_are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who reactive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identnyine information rece'sary to allow county government to better monitor homestead
filings. This information will be kept confidemial and can only he accessed 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
Potts, Vera
It I Box 104 Q�
Hazleton IN 47640
122 — — __ ___- _ __
Vera Potts
4764 E Giro Rd State Parcel Number Leal Description
Hazleton IN 47640-9305
III I III I I I I I I I I I I I I III 26-02-47-006-000.631-017 009-00631-00 PT LOC 5/6 1-10 31.75 AC
In nt t urn ntr tin r tint n nt nnr
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 5 below)
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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
\ )
PART 4:ADDITIONAL INFORMATION
•
. FORM HC 10 1979 ' ^'► To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 79 .
SEE BACK FOR FILING INSTRUCTIONS • '
(We) (W ¢ �-�- C20- certify that on the 1st day of
arch, 195., I,r(We) occurged as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) -6wned
• ❑ are buying under contract
❑ have a beneficial inter st in the taxpayer Q�� /
Property Description in County 91,17_,,o_.,0,1 Township
Taxing District (City, Town, Township): 0
Parcel Number or le al IYescription shown on tax statement:
i , c/o-c-- ►J$ G /- /O --f uuti
• If buying on contract: Owners name (fee simple owner) 3 /. 7C
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
®hereby certify the above statement is true, correct and complete.
'Signature ! Street Address City. State and Zip Code
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 D• Land not exceeding 1 (one) acre immediately E surrounding residential i v (1) 'CO "//�7�o� 0
Other Land (2) /19 a 7"t6' `yf+0 the%"..
Total Land (3) /9 9 /J0
Residential Improvements JUN 2 o 1979 (4) 1Z.9_7o
Dwelling
`f; / %4_2 arage (5) —0— #
// AUDITOR otal (6) 71 4 7 p- ' en/ ran •
Other Improvements (7) 1/ 10 3 9 37c
Tbyprovements - e (
Line 6) plus qu
(7) equals (8)complete. (8) 9/ £D
_
�.>360
a- Ciao huh 4r//- 79
Signature pl AsseSSdr Date
TION BY AUDITOR -
Approved: O it V 1 Date: 61/23/7g