Homestead_Briner 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 ' a
SEE BACK FOR FILING INSTRUCTIONS
.4(We) L —I `' 69 • certify that on the 1st day of
arch, 19 geU , I, (We) occupied as our principal place of resi n the following described real property for
which a�Hoomestead Property Tax Credit is hereby being claimed:I(1
I, (We) 'owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in County �'�p "L' ` --��^ Township
Taxing District (City, Town, Township):
Parcel Number or legal description shown on tax statement: 7 /a614-e-
-7' / 3o-1- 70
If buying on contract: Owners name (fee simple owner)
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.
(She-) l2� / z�2�n � f71-0
/]S iJ ignature e )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) acre immediately
surrounding residential improvements (1) So o '/ 7 o
Other Land (2) 2 7 O 7 B 390
Total Land TEED (3) / 3 -7 0 ./, 6 0 .5-4,"777/
Residential Improvemen s (4) a /
Dwelling
MAY 1 1950 Garage (5) a"° 4___D / ���
rat J al•
Total (6) a / S'O c
Other Improvements 67 AUDITOR (7) — o —
Improvements - Line (6) plus (7) equals (8) (8) 02 / a £0
t .. .reby certify the above is true. correct. and complete. /a / 3 0
Sig a; a of Assessor Date
- ACTION BY AUDITOR -
Approved: Date:
S IMF FORM!)!N IR:/Hrvl MASU D MIN 79-IA
APPROVED BY OOF cr(t TS._Im rtrgWnm BY TIr DRARPFEROF LOCAL rMWEERMMrhI FINANCE It'H.I-Lt1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead sundard deduction.As the receipt of this deduction becomes
mom beneficial.there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax 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 ncesury to allow county government to better monitor homestead
filings. this information will be kepi confidential and can only he accessed by authorized county offcials.The Department of
Local Government Finance will use this information to create tools that will help county offcials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
•
Taxpayer Name Property Address
Briner, Charles P/Cathy J 87569 4/, /fcceSS 8S0/✓-
IIwy41 1
Hazleton IN 47640
101
Charles P/Cathy J Briner
8749 N Access 850 N State Parcel Number Legal Description
Hazleton IN 47640-9209
III I III I I I I I I I I I III III 26-02-30-300-000.101-018 010-00101-00 PT LOT 4 8 PT LOT 1
t n ut t ton nt t nu t rn t nt n rut tt 30-1-107.120 AC
PART 2: TAXPAYER INFORMATION
Owner I ,x First Middle 0 0, _R Last
Ong-Address(numbber and street,city;state;and ZIP code) - - - ame as property add..os - - - - - -
514 r• Acmes NI . 1. Al-wra ( 7 (o . 41e 4D
Spouse First Middle Last
BATA'( 0eiNee_
Mailing Address(Number and sweet,city,state,and ZIP code) e as property address
g1A9 r►' Pc ss g7l) r'. L-t-AaETO(NI I I . d7e4-v
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.
Ow-net 1 S. Date ID-2(ro }
PART 4:ADDITIONAL INFORMATION
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