Homestead_Shoultz (10)1' Oo9 �G 93 00
CUllf i FOR HC(f lEAO PRO ERTY TAX CPaIT FOR 'i R 19$0
•(� - p SEE:BACK:FOR FLUNG INSTRUCTIONS �""
I, ...Yle) 114 •' • • r� ¢ .ddvv Ct- .CL�I.elt�-� certify that on the let day c
March, 193x, , I, (We) occupied as our princital nla o-f residence the following described real
Property for which a llmrnstead Property Tax Credit is hereby being claimed:
,�� / -
I, li omed •
ii are buying under contract
n have a beneficial interest in the taxpayer
Property Description in County L.t_/ . Tb„m h i
Taxing District (City, Tam, Township) :
Parcel thither • or legal description slam on tax statement:
:i V to' Iy , 44 /7-/- i 1. .2347
If buying on contract: O.vnners name (fee simple. owner)
Contract rer^orciel in Recorder's Office - Record lb. Page
If any portion of the residential structure or the land, not exceeding one (1) acre that
irtediately surrourds that structure is used to produce inane, describe the use and portion of
the property utilized to produce ircone
Any other counties in which individual owns or is buying real property: County - TQ::nshio
I hereby certify the above statement is true, correct and cor-plete.
- City, State and Zip Ccu:
ranature Street IrViress y p
*Individual either urns 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 Issessed Itinastea:.
Value Valuation Valuatie:
Laid not exceeding 1 (one) acre innediately ti O / 70
surrounding residential in-rove eats (1) 5O O / 7
Other Land f U / 0 WjA %C `(3)Total Land
// 1 cQ 1 :
Residential In p ro vemen is •
Dwelling (4) • °l �l// 44., /��re/
Garage (5) !!/ ���114 � /i/Pz
Total (6) `'J
�� r//0 S.
Other Lrurrovenents (7) • !!��( /
7 ' l
Tb ' Inbrovenents - Line (6) plus (i) .cnua?s (8) (8)
I hereby certify the above is true, correct, and couplets.
4: r
Date
Mature of PSSesscr
• - ACTION BY AUD1TnR -
lk,, a/ 6, pate: — 13 - 2&
ST,1E Minl!)KIr/%-d.1 ntrnsurn FORM S:A
ArrtrwaoaY STATE YNRUOF nen csttg,n PVAIUBFDDY ME urrMneRrt LOCAL COERNMTAT FINANCE ICH.l-2:4.1
Gibson County Auditor 'IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N Main ,
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 incentive than ever for homestead fraud.Homestead fraud causes higher Las bills for all:therefore.
• HEA 1344-2009 requires mapaven who receive the homestead standard deduction to verify that they are eligible to recehe the ,
benefit and to provide additional identifying information necessan'to allow county government to better monitor homestead
filin r,.This information will be Ltp confidential 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 comity officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Shoultz, Nicholas B/Sandra L
RIBo.
F usco IN 47649
`'
1054 e8 N lo500l✓
i76
Nicholas B/Sandra L Shoultz d,t ,ltc 4.z i-7; tot' 9 76 99
4768 N 650 E State Parcel Number Legal Description
Francisco IN 47649-9218
It'ttll lttltlltLtlt rllrlrrlriTrrl lrirl l���tr�rr��rt�tt�tt��tt� 26-06-17-300-000.693-017 009-00693-00 NW SW 17-1-91.2397 AC
C-1
1
•
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
-_•I Address(number and street,city,state,and ZIP code) -- —�- -- - -- - ------❑-Some as property addres-- - --- -- -
�17�� A) / 50 - c�n /L)zGc ota d 76 Y7
SpouuIsee ,� First Middle Last
`
20L4LO'U_a
Mailing Address(Number and street,city,stale,and ZIP code) [J Same as property address
Y7(0 N re,so c c 1.clA2tat1.J QT6 9 9
•
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
-
fART 4:ADDITIONAL INFORMATION
0