Homestead_Schafer FORM HC 10 1479 •- • To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 77
SEE BACK FOR FILING INSTRUCTIONS
�(We) r " ^"'�'�i° f � ' ertify that on the 1st day of
arch, 19 ' , I, (We) occupied as our principal place of residence the%ollowing 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 rest in the taxpayer ,
Property Description in County
' l�,v Township
Taxing District (City, -Town, Township): U4_Gre--r—)
Parcel Number or legal descriptiA shown on tax statement:
y
If buying on contract: Owners name pee simple owner)
• 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.
Ci� .� .e .P „.+ ,0�� ,f/ 'a�t' -'SC7 to to
'Signature StrPP�3"'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
Land not exceeding 1 (one) acre ��mmetely� � ) ∎O
surrounding residentia pr%vemdi5ts (1) .2. --ti 7Sv q
Other Land m (2) — — —0�— ���������
Total Land . 1 4 1979 (3) 760 Ant2,20
Residential Improvements (4) 76 o-o
at /6A oatwelalgine g (5) 90 . ;
A:G ai�otal (6) % 90 `64 e .
arla
Other Improvements (7) L020 -14.4./.57)
Tc' ' Improvements - Line (6) plus (7) equals (8) (8) g0/ 0 .2447c
I -Why certify the Cbove is true. c
oy
rect. and complete. 31/8
Signature of Assessor -��'(-� Date
- ACTION BY AUDITOR '-
Approved: £. 9 e Date: ../1/9(71
STATE FORM 53569(R3/l-I0) TREASURER FORM TS-IA
APPROVED BYSTATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FTVANCE IC6-!.I"-8.I
IMPORTANT NOTICE TOHOMESTEAD PROPERTY OWNERS
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 ever for homestead fraud. Homestead fraud.-
..uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
standard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
information necessary to allow county government to better monitor homestead filings. This information
will be kept confidential and can only be accessed by authorized county officials. The Department of Local
Government Finance will use this information to create tools that will help county officials eliminate C/
homestead fraud.
- PARTI: PROPERTYINFOILMA ION
•Taxpayer Name Property Address State Parcel Number Leval Description:
William Brent Schafer 6596 N SHILOH RD 26-0557-092-000.676-017 PT MD 92 1-10 4 AC
PATOKA IN 47666 D-I2 C-I
Complete and return to: I®IIDll1®IflIPIIUm1iUllf11�I11m E11110111111111110
•GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 1 ll� aA
PART 2: TAXPAI'ER INFORMATION
Ovmer Ce First 1 e-'•' \ Middle SCI Last
��
Wang Address(nunter and street sty.state and ZIP code)
I Same as papacy address
Spnrcw Fast Middle • Last
Maitrig Address(number and street.city.state and ZIP code) Same as osmium/address
•
Social Seventy Number(last 5 digits) Driver's Llrmselstate ID Number(last 5 digits) Sae Other(please specify in Part 4 below)
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 1 Signature Date Telephone
k.A-)aw fir �
I Jr / l ( )
Spouse Signature Date Telephone
)
PART 4: ADDITIONAL INFORMATION - v .-
• NOV ' 5 2012
GIBSON COUNTY AUDITOR