Homestead_Druley STATE FORM!Ji*IR:/' O TREASLRUA PORN Z IA
.APPROVED BY ST(it WWI)OF MYNA ITS.a.N PRESCRIBED BY nR DEPARTNENTOF LOCAL GOVERNMENT FINANCE M 6-I.I.I_4.1
Gibson County Auditor
101 N M'a'in RIPORTANT 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 exer for homestead fraud.Ilomeste:d fraud causes higher tax bills for all:therefore.
HEA 1344-200c requires taxpayer:, ho receive the homestead standard deduction to verify that they are eligible to recess the
•, r benefit and to provide additional identifying information necesstn'to allow county government to better monitor homestead
filing,.This information will he kept confidential and can only to accessed by authorized county nlbciuls.The Depann ent 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
Druley, Ray M/Annette R
P o Hox
Fon Branch IN 47648
1035
Ray M /Annette R Dailey
P O Box 146 State Parcel Number Legal Description
Fort Branch IN 47648-0146
1t1n 11ut1t 11nt1n11n1t11 l 26-19-19-204-001.334-026 /007-01061-00 INDIAN HILLS 83
D-27
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
Ray Mr V ry le y
g Address(number and street,city.state,and ZIP codes- "— - —' - 0-Same as property adds_sss - - - -- - -
d t3 ox 14-IL Fort bra 1i IN I/ 76Li Se
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
•
re;cril�d.By State Basrd of Tax (Xmnassioners
CLAI��1 FOR HOhESTEAD PROPERTY TAX CRQ)IT FOR YEAR 19g-S ,
, ,
SEE S�,CK FOR FILING 1NSTRUCTIONS -
I,'•���e) K�.q' Q�� �.1�
p:�-ch, 19�� I, 7e) occuaied as our princ
:, -�erty tor which a Hanestead ?roperty Tax
��
oertify that on the lst day of
ce of residence the fol].cx�ing described real .
is hereby �;*u; claimed:
.
I , de ) n a.�,s3'
'�- ie buyinq urrier �ntract
� have a beneficial interest in the ta�mayes
Prooerty Description_ in .��LCJ' '
Taxino.District (City, Twm, wnshi ):
Pascel iltmiber
Zf buyina om m�tract: Owness n�n�e
Ooimty � /V�cJ�'1 �i+mshin
or legal descrintion shown on tax statarent:
Contract recorded in Re�rder's Office - Recora No.
rage
Zf any portion of the residential structure or the land, not e�eeriing one (1) acre that
itmiediately surroturis that stn�cture is used tn pxvduce inca�, describe the use and portian of
the on�perty utilized to pnoduce income -„�—rft—�-,---T�r:r� ... .. „,.
Pny ot'r.s wimties in which irxiividual aans or is buying real property: Coimt �mshiP
Z hereh certify the staterent is true, c�rrect ani con�lete.
�� icrnature Slseet Address City, StatE and 2ip G
*Individual ther aans or is buying imer a oontract ti�at provi.des he is to oay the
property taxes on the residence, or has a beneficial interest in the taxpayer•
- FOR ASSESSOR�S USE ONLY -
. ZYue Cash
Value
La� not exceedin9 1(one) acre inmediately
sisrow�3ing residenti.al i�rovemnts (1) � �.D
�. . - . ...
TOtal Land
Pesidential 7nprovamnts
Other Inrorovanents
Daelling
Gara�e
�G :i��
(2) �
�3) 3 7 0 U
(4)
(5)
(6) a7 �b o
(7)
� '. Imarov�nts - Line (6) plus (7) �uals (8) (8)
I h seby certify the above is true, correct, anl anrolete.
- ACTION BY ?UDITnR -
Date:
Assessed
Valuation
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iianeste�d
Valuation
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