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Homestead_Montgomery (3) • • STATE FORM•t.t„tie 'T MEASURE,FORM TSIA
IPORTANTtNOTICETOHOMESTEADP PROPERTY 0.OWNERS
Gibson County Auditor
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 incentive than eser for homestead fraud.Homestead fraud causes higher tar bills for all:therefore.
• HEA 1314-2009 requires taxpayers who receive the homestead standard deduction to Geri v that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kept confdeniial and ran only be accessed by au horiaed courtly officials.The Ikpanncm of
Local Government Finance will e e this information to create hods that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Montgomery, Roger
402 N(lull d
Fort Branch IN 47648
7697
Roger Montgomery
402 N Hull State Parcel Number Legal Description
Fort Branch IN 47648-9709
1t1tt 11tr r1r11rt t1tr11rr 1r1r1rr1tttillrrrirlrrllr rrrr 1111111 11 26-19-18-302-000.531-0267011-00531-00 HILLCREST 79PT
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
POdthert- e rnONT9oMP21/
ng.Address(number and street,city,state,and ZIP code) - - — J Same as property Odd/ass I ---- -
9'O2 NO2zk R z c- 1,r:.r Ba,►7k TN' 4176,ye
_
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) El Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
sat
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
r � Date
•
wwn Hc ia ism
HescriGeG By State Bwrd of Tax Commissianers
CLAIM FOR HOMESTEAD PAOPEflTY TAX CREOIT FOR YEAR 19 '79
To & FIeE in Wplicaro
SEE BACK FOR FILING INSTRUCTIONS D//�OD��� �a
�(We) ����-�-Q-Q�.- c rtify that on the 1st day of
arch, 19�, I, ( e) occupi as our pri cipal pla 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
❑ have a beneficial interest i tn he taxpayer
Ca-f' �
Property Description in j-k-�-`-��� County ��-�--e�- Township
Taxing District (GiEy; Town,snwnship): �'�- —�/t-a_.._._-G..
Parcel Number or legal description shown on tax statement:
��e.� 7 9 �IJ �2
If buying on contract: Owners name �'� :�mo�e ow�e�i
Contract recorded in Recorders Office - Record
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 Township
�°sE✓ �' rn�th
hereby certify the above statement is true, correct and complete
�
a�a
' 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 -
Land not exceeding I(or�) cr i�iTqed te
surrounding residential improvemen�'
Other Land JUN 1� 1979
Total Land .
Residential Imprc�e,n �
Other Improvements
i
i �.
� •-
Dwelling
Garage
Total
Tm ' Improvements - Line (6) pius (7) equals (8)
I,�by certify the above is true. correct. and complete.
� „ _ .
Signamre ol Asxssor
True Cash
Value
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(2)
(3) �(oo
(4) ,�-�>/�"
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- ACTION BY AUDITOR -
Assessed
Valuation
3 za
3 Zo
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Homestead
Valuation
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Date
Date: �