Homestead_Georges (3) atATE Wall:'t.IR_/fit TaMAR%LER FORM SIA
APPROVED DY MOT 1YMRDew VTl*:Nit arm IRE`nI3m DYntr DPPARWEYT(!LOCAL r.ovawsrwr IAAKE IC(-I.I.r4.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
• PRINCETON IN 47670 Individuals and married couples are limited to one homestead yandanl deduction.As the receipt of this deduction becomes
• more beneficial.there is more incenthe than net-for homestead fraud,Homestead fraud causes higher tax bills for all;therefore.
HEA 1344-22009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible io receie the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.this information will he kepi confidential and ran only he accessed by authorized county officials.The Ikpanment of
Local Government Pinang will use this information to crow tools that will help county ofcials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
• Georges, Roger V/Gloria J
R I Box 215 de
Lynnville IN 47619
8880
Roger V/Gloria J Georges
10904 E 1050 S State Parcel Number Lezal Description
Lynnville IN 47619-8804
26-20-36-300-000.264-001 001-00264-00 SE SW 36-3-9 40 AC
Illlllllllllll IllilelIIIIIIIIItIIIIIIIIIIllileoIIIlllltIl D-19
PART 2:TAXPAYER INFORNIATIOtN
Owner I First Middle Last
( , &r V . i' . , - - -
ag Agaves(number and street,city,state,and ZIP code) Q Same as property address
ingni/ r. Soso S . A-ti fl,-1 11, 1/P, -TN X7/11
-
Spouse First Middle /J Last
a innq Jean UPd2r7E S
Mailing Address(Number and street,city,state,and ZIP code) Blame as property address
I n gat i� lOSfi S L l r,,-, i>///e- T N '/76/ 9
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 Signature Date
PART 4:ADDITIONAL INFORMATION
FORM HC 10 1979 To Be Filed in Duplicate
Prescrited By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 192.
SEE BACK FOR FILING INSTRUCTIONS 00 /— Oo Z6f/ — /oo
ll /i n n
,(We) certify that on the 1st day of
.arch, 19�, 0(we)'occuP9d as our principal place of sidence 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 _-4 x County 42 Township
Taxing District (eitr T-& rt, Township):��4
Parcel Number F_F7 or legal description shown on tax statement:
SEy Sw;r &4 --:? -9 `/oQ -c..L�
If buying on contract: Owners name it" simple owner)
Contract recorded in Recorders Office - Record
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
I hereby certify the above statement is true, correct and complete.
al n n
Address!/ I 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
Value
Land not exceeding 1 (one) acre immediately
surrounding residential improvements (1) .3-0 0
Other Land (2) 7 0 !o o
Total L (3) 756 0
Resident I Irri rovements Dwelling (4) 'y 7 90
JUN 'g79 Garage (5)
Total (6)
Other Imply m r KAA� (7) `/ o
Tofe Imp((ro//v11e nts - Line (WYIIR (7) equals (8) (8) SO3 O
I00 by certif the above is true. correct. and complete. -
Sig re of Assessor
- ACTION BY AUDITOR -
Assessed
Valuation
Date
Date: �'� 7
Homestead
Valuation
i-7 0