Homestead_SeibertFORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 1922
SEE BACK FOR FILING INSTRUCTIONS
We) certify that on the 1st day of
tv arch, 19 7'f I, (We) occupied our principal place of residence the following described real property for
which a�Hoomestead Property Tax Credit is hereby being claimed:
I, (We) LYowned
❑ are buying under contract
❑ have a beneficial inter[ /��st in the taxpayer /�
Property Description in — � �/ -� County / l Township
Taxing District (Git}- Tewri, Township): /?
Parcel Number or legal description shown on tax statement:
Pf-. 51' *Z- s 9 / 0 ,z,
If buying on contract: Owners name (fee simple owner)
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: County Township
I hereby certify the above statement is true, correct and complete.
5i writ Street Address City, State and Zip Code
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 immediate)
surrounding residential impro �y9n (t) ol
135 V
Other Land JI. ILE (2)
Total Land (3)
Residential Improvements � 1979 (a)
Ow i ng
�• �/ (5) %aOZ7-
Il/7 AUDRM (6) ,Z-fit —O
O
Other Improvements (7)
Tot -' Improvements Line (6) plus (7) equals (8) (8),
I b certify the above is rue. correct. and complete. �pp�
Sigruwre essor -- "�
ACTION BY AUDITOR -
Approved:—
Assessed
Valuation
O
Homestead
Valuation
�314D
' Dare
Date: IO
SIRE FORM•3,c IR-r VNI TREASURE0.FORM'SIA
• APERrxto BT 513E EOSRDOF CCOUSTS 9i+ F1119CRIDED BY int DEPMMEMr OF LOCAL GmttNMENT FINANCE IC 11-1.1-114.1
Gibs?in 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 ester for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who recene the homestead standard deduction to verify that they are eligible to recehe the
benefit and to ptoside additional identifying information necesary to allow county government to better monitor homestead
filing,.This information will be kept confidential and can only be accessed by authorized county officials.The Depann>mt of
Local Government Finance will use this information to create tools that will help - liminaie homestead tmud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Seibert, Jeffrey W
R2 Box 135
Fon Branch IN 47&4S
386
Gary W Seibert
7900 S 800 E State Parcel Number LeEal Description
Fort Branch IN 47648-8630
�t�n��ut�r��ur�n��n�t�n�n��u n��t��nt��nr��l rt t�r t�� 26-20-21-200-000.924-001 001-00924-00 PT S NE 21-3-910 AC
D-8
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
6Qry -
®Ig.Address(number end ironer,city,stater and ZIP code] — — — amc us property uddrLaa - - —- -
•7 9 0 0 5 ?o o e /N Y 74
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivels License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
Suss
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 li b le for back taxes and substantial financial penalties.
Owner I Signet • Date
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PART 4:ADDITIONAL INFORMATION
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