Homestead_Riley (5)FORM HC 10 19i9
To Be Filed in Ouplicale
Presorioed By State Board at iar Commissioners
CLAIM FOR
HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19
81
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SEE BACCK_ FOR FILING INSTRUCTIONS
.f�
b (We)
-" t Q 4 � certify
that on
the 1st day of
march, 19 91 I, (We) occl
ied as our
principal place of resirl ce the following described
real property for
which a Homestead Property
Tax Credit is hereby being claimed:
I, (We) �0 owned
❑ are buying under contract
❑ have a beneficial inter st in he taxpayer
Property Description in Taxing District (GAy- Town, Township): `
Parcel Number
If buying on contract: Owners name Oee simple owner)
ty
Township
or legal descriptio shown on tax statement:
r �
/•0SS`Gc
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:
hereby certify the above statement is true, correct and complete.
'Signature
Street Address
County
cdy.
Township
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 -
1
T
Land not exceeding 1 (one) acre r nILYy F
D
surrounding residential improvements
Other Land MAY 11 1Qol
Total Land A
Residential Improvements �� pUOtTOR
elling
Garage
Total
True Cash
Value
(1) S00
(2)
(3) .5`d7 0
(a) Y o
(5)
(6) a D
Other Improvements (7) y 3 3 0
Total Improvements - Line (6) plus (7) equals (8) (a) a `f 8l o
goocertify the above is true, correct. and complete.
Signature at Assessar
- ACTION BY AUDITOR -
Approved:
Assessed Homestead
Valuation Valuation
/70
Date:
STATE FORM 5!MIa_1lfI TPL SUaft FORM ASIA
.MOVED BY STAT[[MAD OFM<ttTS.!nw PRLARrixm BY nuDEPARTMENT OF LOCAL COVER-N WTT FINANCE le••1.1-224.I
GibsCounty Auditor
N Main
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
a PRINCETON IN 47670 Individuals and married couples are limited to ore homestead standanl deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than eser for homestead fraud Ilorrtnreal fraud causes higher in bills for all:therefore.
® 1 �' HEA 1344--3W9 requires taxpascrs who receive the homestead standard deduction to verify that they are eligible to receise the
,3 benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
.1 T ED filings.This information will he eery confidential and can only h.armAUJ by authorized county officials.The Department of
Local Govenunent Finance will use this information to create ads that will help county ofsiats eliminate homestead fraud.
AP r 1 CO IU PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
-,/ . 'J Riley, Jerry UMary A Trust 6,3'74 F 5Sa ,S
GIBSON COUNTY AUDITOR o
Francisco IN 47649
8534 pie,
Jerry L Riley l6-
6374E 550 S State Parcel Number Lezal Description
FRANCISCO IN 47649-9138
26-20-06-400-000.856-001 001-00856-00 SE SE 6-3-9 38.055 AC 010
Ioluillottlellepolitildetill tun I I IItI uI lI uI lI u I I nI I I
-Y/
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
Jerry Z. e e- Y
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' to Address(number and stp�et,city,state.and ZIP code) - - - — �,6ame as p i address -- —— ----
637 Lt. E 5565 Peg ?2G, Sco _ / A/ 11. 76 q
Spouse First Middle Last
Mai` 47777 R1 ( et
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as properly address
6-,3 74-E - 55-0 5 /'ranci5cO 1W + 74 447
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
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�i1ART 4: ADDITIONAL INFORMATION
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