Homestead_Griffith sl'TE FOR,,E",erw+l - - — -- TREASURER roh4:1!A
AMMO"BY ATE rmlINes. n PtY1WBF EPMTNr1(*LOCAL GOVERNMENT FINANCE ICLIA- -!.I
Gibson County Auditor .
IMPORTANT NOTICE TO HOMESTEAD PROPERTY-OWNERS
101 N Main __.__
_ PRINCETON IN 47670 lndividuaLs and married couple are limited to one homestead standard deduction.As die receipt of this deduction becomes .
- more beneficial,there is more incentive than eser for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who receise the homestead standard deduction to verify that they are clieide to receue the
benefit and to provide additional identifyine information necessan-to allow county government to better monitor homestead
filings.This information ept contidrn tial and can only he accessed by authori,ed county officials.The Depannlent of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property'Address
_ Griffith, Steven H/Cheryl K
4198 E Valley Pass
Hauhstadt IN 47639
10925
Steven H Griffith
4198 E Valley Pass State Parcel Number Legal Description
HAUBSTADT IN 47639-7854
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PART 2:TAXPAYER INFORMATION
Owner I First Middle I Last
t1
Steven H. Griffith, MD t'elnxfy Gel CAL
lin Address(number street,city,statc,and ZIP.code) "_ 1. .- ` _ _. t.®�1 Same ass(prrolperty oddness._ _ __ .. -_ __ _
�4t9$ CGc\ G\ R�s5 k�)54e.�k t3 4I b31
\
Spouse First Middle • �� last
c1„Ny( GVV l
Mailing Address(Number and street,city,state.and ZIP code) ® Same as property address
4ket ii Eo,� f G4S S t - . 4-7 35
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
• '
�, CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
su��� Fom, sa�a �as i sa3l
Prestribed by lhe Department ol local Govemment Finance
INSTRUCTIONS: See reverse side !or /iling insimclions.
� FORM
HC10
YEAR
� M�e) � � certify lha e st ay f ar
I(VJe) occupied as our principai piace oi residence the Ilowing descnbed rea erty for which a Homestead Pr T is ere y daimed
❑ I(VJe) owned ❑ Are buying under contracl �AN 1 0 2005
' Have a benefidal interest in ihe en6ty that is liable (or the property taxes on the property and that owns the property or is buying under a wnVaU.
If byvg om m�iraa. Fee Simple ownefs name
where conuacl is recorded
Caunty
Tuvnship
Tming d'aUict (ciry, fown, fownship)
Rewrd numher � Page
r�(ceAuryu_el �/� ` I �e9ai escnp �on�� ^� I ls Ihe property in question:
C' ]rC 1 ll!`�\/ �Y ) /
��\.l�l'T (,.-iV LX ❑ Real propeRy ❑ MoGle Homo V.C. b1J-7)
If any portian of the residential sWMure or Na land not axcaeding one (1 � aae t0at immediatety surrounds that sWCWre is useA la produca income, describa Na use and portion
of the property utitized to produce income.