HomeMy WebLinkAboutHomestead_Black 'rescribed-t3y state warn or .tax w EN..55suzMLL5 /
CLAIIM FOR HONtSTEAD PROPERTY TAX CREDIT FOR YEAR 19'
SEE BACK FOR LING INSTRUCTIONS
I,'-iale) �4 ` IZ �° `- certify-that'on the 1st day of
alert• h, 19 S-(, I, (We) occupied as our principal place of residence the following described real
y for which a Homestead Property Tax Credit is hereby being claimed:
I, (We) tadane9 .
•
rare buying under contract -
C have a beneficial interest in the taxpayer
Property Description in t M County uki to, Township
Taxing District (City, Twin, Onship)
Parcel Number - or legal description shown on tax statement:
Rt. 66-//y as-- 1 _ ii 1, 49Qc.•
• 7. 40 ae-
If buying on contract: Owners name (fee simple owner)
Contract recorded in Recorder's Office - Record No. Page
If any portion of the residential structure or the land, not exceeding one (1) acre that
inmeciiately surrounds that structure is used to produce inane, describe the use and portion of
the property utilized to produce irrnne
Pny other counties in which individual owns or is .buying real property: . County . Rtrwnshio
�ereby certify the above statement is true, correct and complete.
*Signature Street Address City, State and Zip Ccde
*Individual either owns or is buying caner 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 Hanestaarl
Value Valuation . Valuation
-
Lard not exceeding 1 (one) acre immediately
surrounding residential improvements (1) SC0 / 7 0 /70
Other Lana (2) e0 55#/ifSh�/
Total Land (3) .C80 �/.' if VAtultf/
Residential Improvements Dwelling (4) / (2,7 s ° ////
Garage (5) a-7 ( /�������/ /������/
Total (6) / (7 SLit° (olio 65500/
Other improvements (7) /// ,
To Improvements - Line (6) plus (7) equals (8) (8) / 95 `F ° 6,s , o ��,
I hereby certify the above is true, correct, and complete.
�cnature of Assessor
Date °'
- ACTION BY AUDITOR -
Approved: Date:
• • STAR FORM IJ!W Ile J!'+'1 TREASURER IOPN 73-IA
...MOVED BY SLATE 6NPO(e MxnPNA 9v rrsTmmbY nlr DEPMMF.VI(W LOCAL COVERNMrXr rE:ANCE M.N.I Dll
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTYOWN ERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead sundard deduction,As the receipt of this deduction becomes
more beneficial.there is more incentive than ner for homestead fraud.Iomestead fraud causes higher tax bills for all:therefore.
40 ILEA 134-1-2009 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 he kepi confidential and tun only be accessed by authorized county officials.The Depantnent of
Local Government Finance will use this information to create suds that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION .
Taxpayer Name Property Address
Black, Dennis W/Catherine R
P O Box 328
Patoka IN 47666
642
Dennis W/Catherine R Black
P O Box 328 State Parcel Number Legal Description
Patoka IN 47666-0328
26-04-25-400-000.554-020 018-00554-00 PT SE 251118.89 AC
IIIIIIIIIIIlrlit llttll IIl IIllttltltllrtllIlIIl
PART 2:TAXPAYER 1NFORNIATION
Owner I First Middle Last
QM n i S l i a,�� trey 13( a cIC.
tg ACdriss(number and street,city,star,and ZIP code) —- me as property address
po 3Ca8 CPcki-, ko f A) 4 i (c cci
. Spouse First Middle Last
00C+herliht VU..-1-h 8 (ack
Mailing Address(Number and street.city,stale,and ZIP code) R.Smne as properly address
Po 3a8 P°di)1(a, s � (Reeve L��
Other(please specify in Pan 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.
O w I Signature Date