Homestead_Ellis 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 ��
SEE BACK FOR FILING INSTRUCTIONS
0(We) �.�.e_t� ', � ) � - Od•/^� Ivo • certify that on the 1st day of
March, 19 I, (We) occupied s our principal PI of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned .
❑ are buying under contract
❑ have a beneficial interest in the taxpayer ,
Property Description in_ County Z(.l- ,c c,-f--.4I Township
Taxing District.4CityCTnwrt) Tewns+tip): L14--a-a."7...jtc, J
Parcel Number or legal description shown on tax statement:
/31
P,p . o`' , 71--a-t/i3 a,/i.7 /j 34/
��s��,r
If buying on contract: Owners name (tee simple owner) � aeginWaglicalagif
es-4-00 P
Contract recorded in Recorders Office - Record No.R, `f — Page 36 O to
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
thereby certify the above statement is true, correct and complete. Q
. &�o, .. , 4-, 476,10 nature Street Address W. 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
.2 Value Valuation Valuation
Land not exceeding 1 (og a� rar , t!__ ,
surrounding residential improvements (1) '7/() / V 0 / 'C
Other Land MAR 18 1992 (2) — --VD
Total Land (3) .5- `t 0 I4 D�����������
Residential Improvement's ' 0 (4) h11 IV77� ��
AUDITOR Dwelling -� �/, // �fr /
Garage (5) C , n �,,//2b,/ a/ S.( :%
. Total (6) - '&' A---7--(0-0- Z Z:7'
Other Improvements (7) — -J50
T Improvements - Line (6) plus (7) equals (8) (8) -.2-o. 2,0- �
Il.eby certify the above is true. correct. and complete. I I % a.0 S-6'
Signature of Assessor
ji/
�/ /�Y - ACTION BY AUDITOR -
Approved: v"�` • o. l it-u.tA Date: 3'ft- t.
SLATE FORM 53569(R3/8-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2109 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I 1-22-8.1
- IMPORTANT NOTI • E�TO:HONIESTEAD 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
�auses an
s higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
dard 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
homestead fraud.
' . < PARTITPR'OPERTI INFORMATION I
Taxpayer Name Property Address State Parcel Number Lent Description: ,
Joyce NI Ellis 110 S OHIO ST 26-0259-033-000.115-019 E ENLG 131/132/133/134
HAZLETON IN 7660
`761,a �IOII
_Complete.and return to: IQI9�I�111f111111111 III11d11BfI�f�I� 11111Em�i��'l�V�l -
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON LN 47670
' PART 2:T.a.YPAYER INFORMATION ..- ; -. --,:.' - ',. - ' 'S I
Owner 1 First Middle J Last
dG ce There C= I/1S
Maing Address(n•mber and street.city,state and ZIP code) sane as property address
First Middle Last
Mailing Address(number and street.dry.slate and ZIP code) - Same as property address
Social Security Number(last 5 digits) Rivers License/State ID Number(last 5 digits) Stye Other(please specify in Part 4 below)
I _. _ . _ _ PART3: CERTIFICATION- __ 1
Each u
Eandersigned 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.
'Inn Date
/‘ .
tDate Te ephone
( )
1 • ':[PART 4:ADDITION XL LNFORMAT1ON -I
NOV i
I I I ,
t
2 2012
GIBSON COUNTY AUDITOR