Homestead_BertramnAIM FOR M-STEAD PROPERLY TAX CREDIT FOR YEAR i9-L4
S- E BACK FOR FILING INj UCTIONS
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- ACTION BY AUDITOR
Date:
Assessed Bamst „
Valuation . Valuatin
.? o 1-70
1316 o //// / /ER
07 go
Date
STATE FOAM!IN.IA_/YNI TREASULERFORMTS-IA
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• krtnall BY'ilE BOVfoOF xn}t■Mt.2VV PAE3FIBm BY 1IF DEP.ARTKENTCF LOCAL GOVERNMENT MACE K'41.1"-1.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to or homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than ester for homestead fraud Homestead fraud causes higher tat bills for all:therefore.
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HEA 1344-2000 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
filinfg.This information will be kept confidential and can only be accessed by authorized county officials.The Department of
Local Govermnent Finance will use this information to create amts that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION -
Taxpayer Name Property Address
Bertram, James H Jr
409 Vine
Patoka IN 47666
96
James H Bertram Jr
P O Box 222 State Parcel Number Legal Description
Patoka 47666-0222
�t�ttll rrr�t��ttr��lrr��rt II rrt�t�lr�t�rt�t�tLlt'tt II tlll 26-04-24-303-000.092-020 - 018-00092-00 COL DIV OUTLOT 5 PT/8 PT
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2:TAXPAYER 1NFORNIATION
Owner I First , Middle last
9me'S /Y/ gerIrflzn Z
"Ong Address(number and street,city,state,and ZIP code) 0 Same as property address
Spouse First Middle Last
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Mailing Address(Number and street,city,state,and ZIP code) 9 Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)-sues _ —_ ._ _ _
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 Si tare Date
Spouse gnature Date Telephone
(r )
PART 4:ADDITIONAL INFORMATION
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