Homestead_RoethemeierFORM HC 10 1979
Prescribed By State Board or lax Commissioners
To Be Filed in Duplicate "
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 192/
SEE BACK FOR FILING INSTRUCTIONS
00- 00i66-00
t(We) �� % , � % 2, certify that on the 1st day of
arch, 19-7-?— I, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
'Cl have a beneficial interest in the taxpayer
Property Description in I
Taxing District (City —Tewn, Township):
Parcel Number
ty �,, Township
or legal description shown on tax statement:
11 MAIV SE * /,?-3 -?
If buying on contract: Owners name Fee simple owner)
Contract recorded in Recorders Office - Record No. Pace
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
I hereby certify the above statement is true, correct and complete.
Township
.no Zip Cooe
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) S o O
Other Land gam, , �� (2) �Z O
Total Land r i (3)
Residential Improvements 1919. Dwelling (4) 7 �a
Garage (5)
1' Total
(6)
Other Improveme nts jy !r (7)
Tntil Improvements Li (6) plus (7) equals (8) (8) / 3.3 i O
Vby certify th above is true. correct. and complete.
Sigoature of Assessor
ACTION BY AUDITOR -
Assessed Homestead
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ArrR2'En By STATE BOARDcw ACIFIANIA Ym PRFA,JBFD BY nit DEPSRM"YT(f LOCAL tS rRYMENT MN'ANCE M6-1.1--223I
Gibson County Auditor PROPERTY OWNERS IMPORTANT NOTICE TO HOMESTEAD
101 N Main
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 incentne than eser for homestead fraud Homestead fraud causes higher tax bills for all:therefore.
• HE.\ 1344-2009 requires taxpayers who receive the homestead standard deduction to yen&that they are eligible to receise the
benefit and to provide additional identifying information necessary to allow county government to better monitor hortvnead
llinp.Ibis information will he kept confdential and can only hr accessed by nuthnrired count'officials.The Depannlent 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
Roethemeier, David R/ Barbara A
K2 Box 141
Fon Branch IN 47648
8706
David R/Barbara A Roethemeier
6078 E 750 S State Parcel Number Legal Description
Fort Branch IN 47648-8618
�t�rr��rrr�r��rrr�rr��tr�r�rr�r r�� ���tt�t�ttr��tt�tft��t) 26-20-18-400-000.866-001 001-00866-00 PT SW SE 1&397 AC D10
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
17AV l d /` e ei E o L1/21 e Ari e7 ierk
_— ng Address(number and street,city,state,and ZIP code) — — _.. —_ - — 2—Same e as property y Bddres;
6 o 71 & icy s f- 71--
Q KA cL jL cJ
Spouse // First !I Middle / Last
�A 1A4120 7-/.r..a �oe7" er,-aei«`
Mailing Address(Number and street.city,state,and ZIP code) .Same as property address
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 n Date
•