Homestead_LeGrange rlVE FOAM II KIR_t TREASURER PoRV"AAA
• nrrKf%EO BY St OE MAW or AlYX40t.9N PIhYFIDW BY 111E DEPARI'aN OF LOCAL 4KTRVNFTi FINANCE 1e 4-1.1-r4.I
Gibson County Auditor
101 N Main IMPORTANT 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 e'er for homestead fraud.homestead fraud causes higher tat bills for all:therefore.
HEA 1 344--2IX19 requires taxpayers who receive the homestead standard deduction to verify that they ale eligible to receive the
Ibenefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kept confidential and can only he accessed by authorized county officials.The Depanntent of
Local Government Finance Mill the this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Prupertv Address
LeGrange, Elmer
701 Ii John
Fon Branch IN 47648
7692
Elmer LeGrange
701E John State Parcel Number Legal Description
Fort Branch IN 47648-9788 t
ItI1FIIF F F'FI'IFFIFFIIFF'FIIIF IIFI III IFIPIFPII II Illl1111 26-19.18-302-000.438-026 011-00438-00 HILLCREST 67PT —
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Spouse // First Middle Last
WO AMA v CA hi E � R nits 0
Mailing Address(Number and street.city,state,and ZIP code) ly'Same as property address
/b1A Pte' 0, ✓f t1cG�r
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.
FOPM HC 10 1979
P�eurioe0 By S�ate BoaeO ot ia� Commissioners
CLAIM FOR HOMESTEAU PROPERTY TAX CREDIT FOR YEAR 19 �7 9
To Be Fi@a in Uuplitale
hereby being claimed:
I, (We) ❑ owned `r /! �OD/ ���'��
❑ are buying under contract
O have a beneficial interest in the taxpayer
Property Description in G-�-�-�r County 'u""'°"� Township
Taxing District (r;�wn,�ewrtship): �' �'e�"��"�'
Parcel Number or legal description shown on tax statement:
�/,-//cRes7— lo7PT
If buying on contract: Owners
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.
. n /i � � . - -
Counry Township
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/r�haare� � Crty. S:ate antl Zio CoCe �
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Individual either ow s�buying under a contract thai 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 9xceeding 1�)�r imm�t v�
surroundin residential ro e n L (�) // o 0
Other Land
Total Land
,! r. 1- i979
Residential Improvemen�j� /�/��2�
�/ weiling
AUDITOR Garage
Total
Other Improvements
Tr� Improvements - Line (6) plus (7) equals (8)
I�by certify the above is true. correct. and complete.
Signawre o� nssessor
(2)
(3) I / o 0
(4) —�-�
�s> I q-S3�D
(6) --�-�o
(�) —
Assessed Homestead
Valuation Valuation
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- ACTION BY AUDITOR -
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Date: �LI�. �_7_�