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Homestead_Petitjean (6) SIAM MIN!)w IR-:turn MA91tra FORM SIA A PrRrwtn BY STATE 5 DOF MiTV\T5-an/ PRr4NBFD BY TIE DEPART NT(fL(R'AL eswrtgMRrr FARCE We-LI-U-SI Gibson 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 eser for homestead fraud.homestead fraud causes higher tax bills for all;therefore. • HEA 1344-2000 requires taxpayers 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 filing.This information will he kept confidential and can only be accessed by authorized county officials.The tkparntent 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 Petitjean, Herman A Und1/2 Int&Norma A U R2 Box 133 1- 11060 Herman A/Norma A Petitjean 12858 S 200E State Parcel Number Legal Description Haubstadt IN 47639-7951 26-23-16-400-000.776-024 004-00776-00 PT S SE 16 4 10 61.626 AC IllielliellellitiellilelpilloillillultItiolloleldilleolliel PART 2:TAXPAYER INFORMATION Owner I First i Middle Last ng Address(number and street.city,state,and ZIP code) Same as property address--/a 8-5"F $ aOP e ji4tc A f R1 _a ii7 9— 7737 - — . Spouse First Middle /1L Last Wormfi A /!��% f �- eX! Mailing Address(Number and street,city,state,and ZIP code) r �1 Same as property address i s ns g S AD D L PfiGc,�S 14�r e if 7,.9? 79“57 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 1 Signature Date FOflM HC 10 1979 � PreuriGeC By Slate Boartl of ia� Commissioners CLAIM FOR HOMESTEAD PROPERTY TAX CRE�IT FOR YEAR 192�� io Be filea in Duplicate .(We) `T certify that on the 1st day ot .rarch, 19��., (We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby bein claimed: I, (We) � owned �Ca��.3-�[�- ��%%C 6��—�Q77�O�V� ❑ are buying under contract � ❑ have a beneficial interest in the taxpayer Property Description in � County Township Taxing District (�iby�Tawn, Tnwnshinl �,,, Parcel Number If buying Ofl contract: Owners name �� s�moie ow�e�l or legal description shown on tax statement: �'7: s/� sE/� ��-f�-.o -�.i9�� 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 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 _ � �, r - �-. . . _ .. County Township 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 interesi in the taxpayer. - FOR ASSESSOR'S USE ONLY Land not exceeding ��i�i� surrounding resideniia mp v ent j� Other Land Total Land ��y � �)g Residenlial Improvement Dwelling � � /��u� Ga age � AUDITOR Total Other Improvements To' ' Improvemenis - Line (6) pius (7) equals (8) I,�y ceyt+t.� the above is true. correct. and complete. Signamre ol Approved True Cash Value •i � � (4) _!�6 3 -o (5) — �s> /763� �� 93m (8) /� S-6 � - ACTION BY AUDITOR - Assessed Homestead Valuation Valuation �'O �� i ��>> s =�" s -? y oa:e / ��Date: —(�