Homestead_Field STSEL FORM!CIA 1R'1}+MI TREASUMEt FOAM 73-IA
APPROVED NY FIVE DELodiO M M«R IYIA._on PRINCRIDED BY IDI DEPARTME cwR AL GOVERNMENT FINANCE IC 4-1E-2:4 t
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead ntandanl deduction.As the receipt of This deduction becomes
more beneficial,there is more incentive than ever for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
al
HE.\ 1344-2009 requires taxmen.who receive the homestead standard deduction to verify 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 be kepi confidential and can only be accessed by authorized county officials.The Depannlent of
Local Gowernment Finance will lac this information to create toils that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Field,Jack Nicholas/Sara Beth 7 3 W i an p S
_ tot u,.Y 300
Ilaubstadt IN 47639
11115
Jack Nicholas/Sara Beth Field
273 W 1200 S State Parcel Number Legal Description
HaubstadtIN 47639-8812
I rhtllttt 11111111 11r1t1ttlrtlt lttltrttllttlt iii iii..ilrtritli 26-23-18-100-000.320-024 004-00320-00 PT NW NW 18410.736 AC
X
PART 2: TAXPAYER INFORMATION •
Owner I First Middle Last
_RACK. . lU / ct . AS >CI6Lb
•
�g Address(number and street.city,state,and ZIP code) ® Same as property address —
- -- — - - -
' a 7 3 w / aoo S NALJ3STAOTf 1 A q 7639
Spouse First Middle Last
_1A1eA QEI N CIEL0
Mailing Address(Number and street,city,stale,and'LIP code) ®Same as property address
x- 7 3 LU /)UO \S HAul3 STA-/>r 1 1 A X76 39
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 she may be liable for back taxes and substantial financial penalties.
Owner I Signs "� � �Cr-". a Date
FOBM HC tU 1979 To & FileE in Duplicate ��
PrescriOeE By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PAOPEATY TAX CRE01T FOR YEAR 19 � z
SEE BACK FOR FILING INSTRUCTIONS
:�.,"Ye) ��--�-Q-� � r"�- ����4-d— '� °'��"L� � certify that on the 1st day of
t(rch, 19�v I, (We) o cupied as our principal place of residence the following described real property for
iich a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial intere in the taxpayer
Property Description in �-�"�"'— County
Taxing District (City, Town, Township):
DD� -oo.��-oa
Township
Parcel Number or legal descnp it on shown on tax statement:
Pr� .� �.v'% n� W'�y- i s- �-, o
If buying Ofl contract: Owners name ��� s�mo�e owner��.����, QDO.��p -6� °`S�� �,
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:
I hereby certify the above statement is true, correct and complete.
avee� noaress
County Township
�,ur. ��a�e ana uo wae
' 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 Improvements
Dwelling
Garage
Total
Other Improvements
Total Improvements - Line (6) plus (7) equals (8)
I�PSeby certify the above is true. correct. and complete.
o� Asseswr
True Cash
Value
��� So 0
' (2) —
(3) So�
(a� a 3 � �l-o
(5) —
(6) a � 1'i-o
(�)
�8� a3��-o
- ACTION BY AUDITOR -
Assessed
Valuation
1'7 0
.
�j�jj/��j/
�j���j�
_, ��
�iy_ �
Dace
Approved: Date:
Homestead
Valuation
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