Homestead_Johnson SITTE FORM!):w.RU saA T TASUIEA FORM 73-IA
Arm -Tern BY MATE YNADOF ACCOUNTS.bra PLEST®W BY lie.DEPARTMENT OF LOCAL GOVER'Nr%r FINANCE IC 4-1.1-2:111
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 dun ever for homestead fraud Ilonestead fraud causes higher tax bills for all:therefore.
HEA 1544-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receise the
benefit and to provide additional identifying infonmanon neresary to allow county government to better monitor homestead
filings.This information will be kept confidential and Lan only be accessed by authorized county officials The D epannrnl 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
Johnson, Thomas David/Cynthiana
Sue
R2 Rot 345
Elberfeld IN 47613
8858 /O7017 /S 54"57
Thomas David/Johnson Z 2,-4ji /at(?)
10127 S SR 57 State Parcel Number Lesal Description
Elberfeld IN 47613
- - — — -- -- — - -- -- -- --26-20-32-300-000.395-001—AC-00p o 00 PT NW&P_T.SW 32.3.9..548_ _
PART 2:TAXPAYER INFORMATION
Owner I First Middle // Last
7 homes I� �r0IC/ X10 it)5o4
•tg Address(number and street,city,state,and ZIP code) - --- ❑ Same as property addrss-' - - -— - -/Gig.? S: 5 R s`) L- /l ear //ti 4/ 7 G '3
/
Spouse First Middle Last
LI Nftita S• Jo Aiu50A)
Mailing Address(Number and street,city,state.and ZIP code) Same as property address
/O at 5- 52 s-1 E/h-er its/ / y74• 3
-
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
Prescribed By State Board of tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR lg-Z,9—
SFF RACK FOR Fit INC; INSTRI ICTIONA
(We)
vlarch,
which I
To Be Piled in Duplicate
�Q�_ po�ys =vo
J
ify that on the 1st day of
described real property for
I, (We) d owned
❑ are buying under contract
❑ have a beneficial interest I the taxpayer
Property Description in "=e' County eLi5�17 Township
Taxing District Township):e > U
Parcel Number or legal description shown on tax statement:
1521 IfIyq Sink 307 -.3 - y , s�S o98
If buying on contract: Owners name (tne snop1e cn.ne`) A- j yf< 3 ;Z -3-V
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.
R.
9gna ur Street Atltlress Lily. State and Zip Caae
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 (onfacr� immediately
surrounding residential improvement
Other Land lrta
Total Land
Residential Improvements
Other Improvements
' A1g
Garage
Total
Trx..) Improvements - Line (6) plus (7) equals (8)
iby certify the above is true. correct. and complete.
' Sign ere of Assessor
Approved:
True Cash Assessed
Value Valuation
(2)
(3)��
(4) �Yo,R O
(s)
(6) oao
(7)
(8) i fe'o a a
- ACTION BY AUDITOR - _
Homestead
Valuation
�OO
M
Date
� Date: