Homestead_Frederickhesui0tj Uy Slwc 9oa:o of tax comnuss,onYB
CLAIRI FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19
SEE BACK FOR FILING INSTRUCTIONS \�
�'�e).1 ^� � certify that on the 1st day o! _
ch, 19 I, (VJe) occupied as our principa lace of residence the following described real property for
-which a�Hoomestead Property Tax Credit is here being claimed:
I, (We) t23' owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in County nn Township
Taxing District (City, Town, .Township): A rug
Parcel Number or legal description shown on tax statement:
P m�l4 -I-�D 1�99gC-
If buying affi a(21.—� rs name (lee simple owner)
� aract 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 t4 prdcrae income, describe the use and portion of the property utilized to produce income
Any other counrW! it which individual owns or is buying real property:
h
"'ereby certify the above statement is true, correct and complete
County Township
/ g..aWre _ _ tree) AtlO:ess .. I) C�ly. Seale and Zip cone
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 -
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other Land
Total Land
Residential Improvements Dwelling
Garage
Total
Ot�lmprovements
Total Improvements - Line (6) plus (7) equals (8)
1 hereby certify the above is true. correct, and complete.
$,tjNIVIC OI A�SI.5501.
cL4,,, t,5-vn vtx --
True Cash Assessed
Value Valuation
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
ACTION BY AUDITOR_:
oae.
Homestead
Valuation
1
' SLATE FORM!Mt.tR2/' 0 TREASUau roaM 75-IA
AnitrwEO B1 STATE Mt1RD MT MnA',\n S.5aM rrL ,1nrn BY air DEPARPA TOF LOCAL r)V RNMFNT FINANCE K'VEt-L`a.r
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 e'er for homestead fraud homestead fraud causes higher tax bills for all:therefore.
0 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 identitvine information necessary to allow county government to better monitor homestead
filings.This information will he Lep cnnlidemial and can only h:accessed by authorised county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Frederick, Kevin D/Brenda J
..--R- cr-
..
- - - — _ _ - ._ _ _ Ilazleton IN 4740
187 _ ._ _- . - _.._ - -
KeV n f)/ rends J Frederick �a C
1 Box 46 Aa '� 3
Hazleton IN 47640-9234 State Parcel Number Legal Description
ii,ttt'tlrtt tltlrtlltrltrit tlrt�tl tt,ill 26-02-58-014-000.295-018 010-00295-00 PT MD 141-101.1910 AC
It lit llttrlt'Ittta
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Re v; n -Deo-n Rec�h.ri r
11,g Address(number and strap,city,state,and ZIP code) - —. - - ID-Same as property addrsa --- - ——
° 1:17-CAI f/ r‘ /C or) 7y `fyloVb
Spouse First Middle (' ( _ Last
g/'end� CJ219e_ I—t:edef-i( _/_
Ma dim Address(Number and street,city,state,and ZIP code) 114.2 -e as property address
,3?a E-7 75 f`/ �a 7/ k , 1,1/ 4--/76,ya
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 eliuible 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 Signature Date
PART 4:ADDITIONAL INFORMATION
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