HomeMy WebLinkAboutHomestead_Smith (2)FORM HC 10 1979
Prescri0ed By stale Board of Tax Commissioners
To Be Film in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 1929 /
OSEE BACK FOR FILING INSTRUCTIONS nn
10(W, q[ 6� �) - -- of
,4arch, 19-Z-�?- I, (We) occupied as our rincipal place of residence the followir" _ —_ ._ for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned --
❑ are buying under contract
❑ have a beneficial interest I the taxpayer
Property Description in / / County Township
Taxing District (G4y- Tavaa- Township): A, y
Parcel Number or legal description shown on tax statement:
If buying on contract: Owners name (lee simple owner)
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 produc7 income, describe the use and portion of the property utilized to produce income
Any other counties in which individual owns or Is Duying /het property:
hereby certify the
above statement is true,
correct and
complete.
(,, �.a^° %/, �bs�Y✓!Li
��011.. " 1 , ¢iYYt.tiLv
`� 1. v /.
/ �J- c..vs
County Township
/-0 (o r Y
Stale 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.
R USE ONLY -
{ True Cash
Value
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
(1) Soo
Other Land
(2) o{ a So
7So
Total Land
(3)
Residential Improvements
-fU ^! ? � 19 %9Dwelling
(a) & /,g o
Garage
(5)
7
T
raj
(6) --v /kjo
Other Improvements
(7) of .So
Tr" Improvements - Line
)
(6) plus (7) equals-(B)
(s) 4:2 q-30
I 'oby certify the above
is true. correct, and complete.
Signature assessor
- ACTION
BY AUDITOR -
Assessed Homestead
Valuation Valuation
/7o
3er:o
'75--/ -72
Date
Date: 6 --2-1 z- 7y
VOTE FORM 5,40 iIC/:wl TREASURER IO10111A
APPROVED DV sr11E BOARD loo vfl':NTS.rior PnsttBmm BY nit DEP.ARThONTOELOCAL GOVERNMENT FINANCE ICLI.I1'l.I
0 N Main
101 N Main Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101
PRINCETON IN 47670 Individuals and married couples are limited to one homestead sundial deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than can for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
REA 1344--2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recehe the
benefit and to provide additional identifying information Accessary to allow county guremment to better monitor homestead
tiling:.This information will he kept confidential and ran only he accessed by amhotiaed county officials.The Department of
Local Government finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY LNFORMATION
Taxpayer Name Property Address
Smith, Elsie M Life Est/Rick/Rex
8249 1:900 S
Buckskin IN 47647
8806
Elsie M Smith
8249E 900 S State Parcel Number Legal Description
— --- -13UCKSKININ 47647— - - - .-- - —--- - -- -- -
26-20-28-200-000.352-001 001-00352-00 PT E W NE 28-3-9.62 AC
D-19
PART 2:TAXPAYER INFORMATION
Owner I First Middle vairr-u/✓/,(()
Last
v
Its Address(number and street.city,state,and ZIP code) Elicirne as property address -
Spouse First Middle Last
Mailing Address(Number and street,city,state.and'LIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
Seer
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 Date
•