Homestead_GrayFORM MC 10 1979
Prescriaed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 1 7
SEE BACK FOR FILING INSTRUCTIONS
7o Be Filed in Ouplicale
00134
0,(We) certify that on the 1st day of
.larch, 19 79 , (We) occupied as our principal place esi ence 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
Taxing District (Git}' -Town, Touansb4�):
Parcel Number
If buying on contract: Owners name llee smpie owner)
Township
or legal description shown on tax statement:
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.
- .&u Q 4 .
b� Sox a5-2L
PatACL "CL, K-766,4
'Signature
S- 30 _
Street Address
pity. State and Zip Code
Individual either ow{���$$$$r is buying under a contract
that provides he is to pay the property taxes
on to
�7(SOR'S
de ce, beneficial interest in the taxpayer.
USE ONLY -
MAY 311979
True Cash Assessed Homestead
Value Valuation Valuation
Land not exceeding 1 (one) ac
surrounding residential improvem
tS AUDITOR
(1)
Other Land
(2) —
Total Land
(3)
Residential Improvements
Dwelling
(a)o
4
Garage
(5 O—
(6)
Total
(7)
Other Improvements
T ' ' ' mprovements - Line (6) plus
(7) equals (8)
(8) —a o l�It3
by certify the above is true.
correct. and complete.
X3390
Sgwmre of Assessor
Date Or
- .ACTION BY AUDITOR -
Approved:
Date: _
SIAiE UORM!),ea,El S1PI IAFASUIER roaN i11A
.Vngl,EtaY[1VEMMRDOfAryv*WrS,]uN P63WBEDBY tl1EDEPMnaarroFLOAIGO VERNMrrrFD:ANCEIcHI-rat
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
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 lax 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 he kept confidential and can only he accessed by authorized county officials.The Depanment of
Local Govenunent finance will me this information to create toots that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Gray, Herbert 0/Sarah Jayne X
Vine-Back ST /
Patoka IN 47666
454
Herbert 0/Sarah Jayne Gray
P O Box 157 State Parcel Number Legal Description
Patoka IN 47666-0157
�rlttllttt 1r11ltr11l tt11rr 11 11r1r1r1rr r1r 1t 1t1(ttltlltt� 26-04-24-300-000.139-020 018-00139-00 FISHERS 2ND ENLG 24
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
H E- RQERT a . GRA )/
Ilitg Address(number end street,city,state,and LIP code) — --– – - Same as property address — - — - -
to BARNES ST Pct- BoX 155 ( To WH 1 7JN . (/ 7 (066,
Spouse First Middle Last
SRRR s G RA
Mailing Address(Number and street,city,state,and ZIP cod e as properly address
3010 BARN-Es sT P.o. oo 1Sr7 PRToWA 1 AI 1,17666.
53n1
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 roperty. 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 I Signature Date Telephone
b /1n ( q-09 -‘o (81a ) 779- SaLI/
Spouse Signature Date Telephone
j C ; ' .)dAl I Lf- -OR - Io ( 8/x-) 779- 5a 1f
PART 4:ADDITIONAL INFORMATION
•