Homestead_Kerney 'LATE I ORM5M...de/Wei TITASURER FORM 741A
.Venom BY SLATE WMPO of Yrl CM'S.9w PtI1W➢rn RV 11W UEPART e.T Or L(RAL GOVEAVMIT'T FR<ASCE B'•1.1-Z-l.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple are limited to one homestead standard deduction.As the receipt of this deduction becomes
S more beneficial.there is more incentive than e'er for homestead fraud.Iomestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are-eligible to receive the
benefit and to provide additional identifying information flecestary to allow county government to better monitor homesead
tiling..This information will he Lep conlldential and can only he accessed by authorized county offici,ds.The Department of
Local Government Finance will use this information to create tools that will help coon y officials eliminate homestead feud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Kerney, Paul W/ Lesa J
306 W Walnut
Fort Branch IN 47648
6823
Paul W/Lesa J Kerney
_ _ 306 W Walnut _ _ _ _ _____ _ State Parcel Number Legal Description
Fort Branch IN 47648-1338 _ _� _ —_
IILIILttLILt1LFILJ1ttrllrrllrttlllLlLlLrtrllrrllttrl 26-18-13-403-000.394-026y 011-00394-00 WEST ADD 4
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
P4Q WI Li Ke21JE y
�e Address(number and strut,city.state,and ZIP code) amens proper oddrsss
Spouse First Middle Last
LESA JoAs sJe /kcR/V5'( -
Mailing Address(Number and street,city,stale,and ZIP code) E'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 Signature Date
as.% .... ! 1
PART 4:ADDITIONAL INFORMATION
• •
In �r 1 i.0 111 l`I�'I::.I:t'
RewiAea 9y Slate BwrG ol im Commissioneu .
.• ` CLAIM FOR HOMESTEAD PROPERTY TAX CREOIT FOR YEAR 19�
' SEE BACK FOR FILING INSTRUCTIONS ��L6�n,�
D,\`-� � /� vi/ (�V
�We) � I � � .lJ � � ifou �i� �st� � ( p �l �Yi-Q-.�--i certify that on the 1 st day of
i�� rch, 19 I, (We) occupied as ou� pnncipal pl e of residence the (o owing described real property for
which a Homeslead Property Tax Credit is hereby being claimed:
I, (We)� Owned
❑ are buying under contract .
❑ have a beneficial inte�rest in ihe taxpayer
Property Description in ,�'�A X)A1X1�K� 7
Taxing District (City, Town, Township): �
Parcel Number
Township
or legal description shown on tax s�atemenL
LJ-e.�— �C�c� . — �i
Ii buying Ofl coMract: Owners name ��ee s�mo�e owneq
� Contract recorded in Recorders Of(ice - Record No. � Page J � _
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 olher counties in which individual owns or is buying real property:
certify the above statemenl is true, correct and complete.
30� l.c)•
. , �J , s�,��
County Township
Gry'. Staie and Zin Cpa.
' Individual either owns or is buying under a contract that provides he is to pay ihe property taxes
����the residence, or has a beneficial interest in the taxpayer.
� - FOR ASSESSOR'S USE ONLY -
(wAR 2 7 19B9 .
Land no ��b�'�re immediately
surrounding resi en ia improvements
Other Land �
Total Land
Resideniial Improvements Dwelling
Garage
Total
(�)
(2)
(3)
(4)
(5)
(6)
True Cash Assessed Homestead
Value Valuation Valuation
Oth Improvements (7)
Tot�iprovements - Line (6) plus (7) equals (8) (8�
I h2Yeby certify the above is true, correct. and complete.
Signature ol Asseisor
- ACTION BY AUDITOR -
�
��,,��: 3/a 7/�g