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Homestead_McConell FORM HC 10 1979 . To Be Filed in Duplicate Prescribed By State Board of Tax Commissioners • r CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 7 9 I SEE BACK FOR FILING INSTRUCTIONS "We) alit[/AM /77. -T E •&df+&ce,.t ✓u Me file that on the 1st day of March, 19_ I, (We) occupied as our principal place 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 0/as°"J ' County 1,1' T& -Pi'ie,e_ Township . Taxing District (City, Town, Township): (..<_)I/ re /C,//��vc2 Parcel Number I or legal description shown on tax statement: qq .$e 54 a6-/-// AS 7T- If buying on contract: Owners name (tee simple owner) -5- FR 'E1' 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 ,ere rtify the abov- state nt is true, correct and comple �gnawr� j Street Address / City. 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 Value Valuation Valuation Land not exceeding 1 (one) a in edia .. surrounding residential improvjne ,nt E D. (1) Soo /7o /70 Other Land (2) CO .74.07-10 to, Total Land J U L t-- `.' fig (3) SSo -ad' 19019,�jjjjjjj Residential Improvements — 43)1= (4) .2 z s /o ��������� �, (5) - „ / 4,9 0R (6) 22 3 r o ono-- . , 7 Other Improvements (7) — — Improvements - Line (6) plus (7) equals (8) (8) 2 28/ 0 —. I`he?eby certify the above is true. correct. and complete. 10 no C_ a 2 -n- 7-or?‘ - 7 9 Signature at Assef pr Date V ACTION BY AUDITOR - �y Approved.9 �� Date: _7-0? 9 � - / $1a t FORM inn.In 14M1 M.ISLIERfOtM i}IA AFFROVED PT SI VIE M EO Of ArtnUNTS.Zing nrrmsm BY nit DEPARTMENT OF LOCAL fiO\SLNMTNT FINANCE Its .I-L4I Gibson County Auditor 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS PRINCETON IN 47670 Individualy and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes more beneficial,that is more incentive than ner for homestead fraud.Homestead fraud causes higher tax bills for alt therefore. HEA 1344-2009 requires taxpayers who receive the hotnestead standard deduction to verify that they are eligible to receive a the benefit and to provide additional identifying information necessary to allow county government to boner monitor homestead filing.This information will be kepi confidential and can only he accessed by authorized county officials.The Oilmatent of Local Government Finance will toe this information to create tools that will help county officials eliminate homestead timid. PART 1: PROPERTY INFORMATION Taxpayer Name Property Address McConnell, Wm M II /Charlene J RI Box 110 Patoka IN 47666 638 Wm M/Charlene J McConnell II 705 S Old Patoka Rd State Parcel Number Legal Description Patoka IN 47666-9003 �tIttIItttIrllt 26-04-25-400-000.547-020 016-00547-00 PT SE 251117.291 AC rt��ttt��tt�r�tt��rtt�� ��t��tttt�t�tt�tt�� X PART 2:TAXPAYER INFORMATION • Owner 1 First Middle �/ Last 1.147/7/1a m �Y1a,, �i 0 % l©il/?e,// g Addfess(number and street,city,state,and P cod -slog 07% /i1 /o 7(a X74 Spo ' / I First Middle �r Last Mailing Address(Number and stra,sit` t4 ' code)/ / / // ��'./_�/�S/+am�Same as pmpeny�addres!s � /C/., 5 C�l^, I�LJ/^/(// //,.(Q/ `Ill-�/�CY//� ce. 41 /\ �,C�,_ / /(7 g-'7 . :• 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 taxe. • substantial financial penalties. Owner I Signe rc A Date •