Homestead_Riley (3) / flan FORM IIMIIc/,.o TP.FA91[R FORM YIA
\PPRrsrn BY FHTE BOYNDM'.MTncMcs,n PEEYRBD BY TEL DEPARTMENT OF LOCAL COVERVND.i FINANCE k' LI-24.1
p. Gibson County Auditor
t 101 N Main ,
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
z PRINCETON IN 47670 Individuals and married coupler'arc limited to ore homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than eta for homestead fraud.Homestead fraud causes higher tax bills for all;therefore.
4`) HEA 134 4-2IX9 requires taxpayers who receive the homestead standard deduction to verity that they are eligible to meene the
benefit and to provide additional identifying information necessary to allow county gormrnent to better monitor homestead
filings.his information will he kepi conlidemial and can only he accessed by authorized county officials.The Department of
Local Goverment Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Riley, George L Jr/Karen S
RI Box 321
8549 — _ ____ . -— - - —
George L/Karen S Riley Jr
7751 E 550 S State Parcel Number Legal Description
Francisco IN 47649-9129
26-20-09-100-000.475-00 001-00475-00 PT W NW 9-3-9 2 AC
IIIltllll•Il loll dill'.I••I•IlllllII.,I.II.IoiltIrurllitil D-8
l .....?
' -- PART2:TAXPAYER INFORMATION
Owner I 1 First Middle —� Last
Vi�� .�5.� 7 le. y ,1i.
•g Addressl((n number and street.city,state,and ZIP code) " - -- — !— �Sawx as properly address - -
77S1 5Sv F•a ncifeo tx- t 7Cg7
Spouse First Middle Last
Mailing Address(Number and street,city,stale,and ZIP code) as property adeLe-
? 7S/ f CCO S Erik-cifCO =N 176 (69
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 hack taxes and substantial financial penalties.
Owner I Signature Date
PART 4:ADDITIONAL1INFORMATION
i
FUBIA Hu IU 19"J
Prescribed By Stale Board of lax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19a
SEE BACK FOR FILING INSTRUCTIONS / 0C /— O 0 5/ %S —Oa
r�j�Ne) A \n` A Y certify that on the 1st day of
ch, 19 1, (We occupi as our principal place of reside the following described real property for
which a�Hoom stead Property Tax Credit is hereby being claimed.
I, (We) el wned
❑ are buying under contract . -
❑ have a beneficial interest in -the taxpayer
Property Description in County n � Township
Taxing District (City, Town, Township): C" C��.Y�SI-�
Parcel Number or legal description shown on tax statement:
44�� ee simple o ner) V �V
If buyingl,on�y''co:,ntra�i )rs name j�e�trl
��� F1�G_ tract recorded in Recorders Office - Record No. Page If any port a8rof the e�si�ential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure i lds�c Co irMuce 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 Townshin
W �r eby certify the above statement is true, correct and complete.
LQ
1 Street Actress city. Stale and Zip Cade
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 Assessed
Value Valuation
Land not exceeding 1 (one) acre immediately
surrounding residential improvements (1)
Other Land (2)
Total Land (3)
Residential Improvements Dwelling (4)
Garage (5) /
Total (6)
Other Improvements (7)
Toff provements - Line (6) plus (7) equals (8) (8)
I hWy certify the above is true, correct, and complete.
Signature of Assessor
Tolkin YmS�ritliolim
Approved:
nam
Date.
Homestead
Valuafinn
q -a) -99