Homestead_Burns 'rescribed By State Board or Tax Conmissioners
CLAIM FOR HCNtSTEAD PROPERTY TAX CREDIT FOR YEAR 19'
' SEE BACK FOR FILING INSTRUCTIONS
•
I _ dee) !d o a- /�'.• certify that on the 1st day of
' h, 19 S-4, i, (We) ocSupied as our principal place of residence the following described real
. ty for which a Homestead Property Tax Credit is hereby being claimed: -
I, (1 e) owned
❑ are buying under contract
E have a beneficial interest yin the taxpayer �/` p
Property Description in s � h��y -r" County y Imo!1 /` , Township
Taxing District (City, Tazn 7/i'- / ^-1.-^-I
Parcel Number • or legal description shown on taxes statement:
g '/ ea /JSt //- / - /) o? • .2 oQc,
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
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
sr -. certify above statement is true, correct and complete. •
X gjf / e , Ate/ / s-2//X
.turd ' / Stree ess ty State'ani Zip Code•
*Individual either owns or is buying uner 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) 45 Cc / 7z) �����// 7 0
Other Land (2) / 70. S t) / I'SAV
Total Land (3) 670 a02- D ��������-���
Residential Improvements Lwelling (4) / / / 70 47 /
Garage (5) /
Total (6) / / i7o 3720 3772-o
Other Improvements (7) ///������/�/�//////
Tc Improvements - Line (6) plus (7) equals (8) (8) / / / 7o 3 70-0 /////O/ r
I hereby certify the above is true, orrect, and complete.
II r 2 ' y/, ?Ezz .
Signature of Assessor ✓ to .
- ACTION BY AUDITOR -
A orovd:': Date:
n SIME FOtM`Jw 1RU'.M0 MEASURER FORA(YtA
SPPRT'Ef BY MATE swat,of Y.IRIND,]n+ PRFYIhBrD BY nth DEPA0.TNIEYF E LOCAL onvasMEAl FINANCE IC I-11-rant
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 incenme than ever for homestead fraud.Homestead fraud causes higher tax bills for all:therefore,
• HE:\ 1344-2009 requires taxpayers who receive the homestead standard deduction to verity that they are eligible to recent the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
tiling.This information will be kepi conlidauial and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tails that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Burns, Mark R
--------
_
— 550 N/Cunningham Fern•Rd
_- _ - — Patoka IN 47666
353
Mark R Bums
1521 W 550 N State Parcel Number Legal Description
Patoka IN 47666-9051
26-04-11-400-000.130-018 010.00130.00 PT E SE 111113,3785 AC
Illtolittultilittlimiliellittillitiltliteillitillettlitillti
X
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Al/A klC40-, I) 4 o ,ert.'
tg Addicss(number and street.city,score,and ZIP code) -- - - 111.-Fottice-as property add - - -- ---
)SL i w L37-5-0 N ch-JZAit -1-177"/ ,i7ig
Spouse First Middle Last
Mailing Address(Number and street,city,slate,and ZIP cork acne as property address
i5-017 Z(/. 5"5p A -item- -/U -
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 I Si attire Date
0
•