Homestead_BetuliusFOF.M HC 10 1979
Prescri�e0 By Sla;e Board al ia. Commissiacers
To Be FiIN in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19��L
SEE BACK FOR FILING INSTRUCTIONS
�(We) �g�'�^-�-« �� � lZ�-u�- certify that on the 1st day of
March, 19�, I, (We)�occupied as our princip place of residence the tollowing described real projperty for
which a Homestead Property Tax Credit is hereby being claimed: ��O _OG�. D� 7'�O� �
I, (We) O owned �� -�� y OD� �Q�Q J' d�
❑ are buying under contract
❑ have a beneficial interes in the taxpayer
Property Description in �c�! Counry Township
Taxing District (Gity; Taw�Township):
Parcel Number I I I I � I I or legal description shown on tax statement:
0�.�/F�i Sw�i /G-y-io /7y�.�
If buying on contract: Owners name �'� �'"'o1e °w"e^ �(�!�-ih�°.rj'� Oh S� �7f
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
_ �1 _ , _ I _
a
,K��
Stree� naaress
County Township
�;�. �7��J"
i�dle antl ZiD COtle
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 1(one) acre immediately
surrounding residential improvements
Other Land �.'�� , ����
���
Total Land
Residential Improveme� t�; s
UIV
� i - $�: . ;��y�� _�� Total
Other Improveni��✓ ii: ���������
�Improvements . Line (6) plus (7) equals (8)
I-. _,�by certify, the above is true. correct. and complete.
True Cash
value
(�) .3 00
c2) _3 ? o
(3) � � °
(4) �
(5) � .«--
- ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation
—L-)7_�
/a o
� �SS �
Date: _(�—lD=�—
•
SIAlh FORM!I t iR t uPl IXF-1NIIR Mini T3tA
.AP? EO BY STATE DIWM Or MMOLNR.]m filYW➢fn BY THE DEPARTMENT OF LOCAL GDTttSMfAl FINANCE KC11-1.1-U4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 IndividuaLs and married couples arc limited to one homestead sandani deduction.As the receipt of this deduction becomes
N more beneficial,there is more incentive than ester for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
illi HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to reecho the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This infnrnulion will he kept conlidential and can only be accessed by authnrimd county officials.The DEpanntent of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Betulius, Allen/Gayle
—. R213ox 117A `/
Nkal
Ilauhstadt IN 47639
11041
Allen/Gayle Betulius
1733 E Warenton Rd State Parcel Number Legal Description
• - HaubstadPlN 47639-7944
IIItJLi ell IIt11tIIILIt1LItIIJIrrlrrLlttLllltttlLuiuIII 26-23=16-300-000.089-024- "0w-000ss00WARRENTON 50 PT —--
PART 2:TAXPAYER INFORMATION
Owner I First Middle - Last
41) 13 of bi1.4 C4ahjes e'er-el
•uAddtcts(number and stmt.city,state,and ZlPcode) .. .--. _ _.___ _ _- __- - _ U-Samcm'pmpervitTd
/ 7 3 3 �� 1 r tint O N R . 4 a h 5 t4 4 t---1---h ' 7�c3 Q
Spouse First Middle Last
CA4w /er, "Cx G43 ( -e--- 730- `e. lelu c
Mailine Address(Number and street,city,state,and ZIP code) /Santo as property address-
/71/
PART 3:CERTIFICATION - -_
Each undersigned certifies,under penalty, of perjury,that the above and foregoing information is toe 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
go