Homestead_Ellis (2) STATE FORM'!s'qR_/fort MSSUIIAEOSM T5-IA
.APPRrw'EB BY't ATE EO&RDOC M}R:\Tt._Vr1 FRf3AJBWDY THE DEPARTMEVT(K lrELL roVER.YMTT'T FINANCE IC ILIA-224.1
Gibson County Auditor
10,1-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 ewr for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1343-2000 requires taxpayers who receive the homestead standard deduction to verity that they are eligible to receive a the
benefit and to provide additional identifying information necrvey to allow county government to better monitor homestead
filings.This information will he kept confidential and can only be accessed by authorized county officials.The Depanment 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 - Properly Address..__ -
- Ellis, Ray/Dorothy
R l Box 274 8 \�
Francisco IN 4764'
4786
Ray/Dorothy Ellis
2628 S 750 E State Parcel Number Legal Description
Francisco IN 47649-9053
26-13-28-100-000.181-004 002-00181-00 PT N NW 28 2 9 10.0583 AC
f n ofIt II ur I I I f I I f I n I I nn I f I nt I I ut It II II I nr IIf I
C-1 D-6
•
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
JERRY( R ELLzS
40ag Address(number and street,city,state,and ZIP code) - -- -— Ei Some as property address— —
Qc as' S. 7So E_ Fgj ,JctSc_o el_ IQ 474C19
Spouse First Middle• Last
eioROF \ (1-K L ELL:L- S
Mailing Address(Number and street,city.state,and ZIP code) ❑ Same as property address
aLa% S. -75-0 FRRA)c ... sco zp-) % 76, tf9
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 Dale
•
CLAIM FOR HOMESTEAD PROPERTY TAX L'REUIT FOR YEAR 19 !U
SEE BACK FOR FILING INS IRUC 11014S J V16 -CIO,/61-00
1, (We)�IC) codify Ih:11 on the 1st day of
®March, 19�, I, (We) occupi as our principal place of residence the following described real properly lot
hich a��Hoom�mestead Property Tax Credit is hereby being claimed: /
I, (We)'r� owned O��y_�3 ����1/O- 600.1 -pl 4G7 �
❑ are buying under contract
❑ have a beneficial interest in• the taxpayer
Property Description in yQ - County Township
Taxing District (City, Town, Township): C4al�
Parcel Number or legal description shown on tax statement:
N to 14 CA a 9 6•"A c
If buying on contract: Owners name (lee smote
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 properly utilized to produce income
Any other counties in which individual owns or is buying real property: County I ownship
I hereby certify the above statement is true, correct and complete.
Vsheet AOaren CH, star jya,.
Individual either owns or is buying under a contract that provides he is to p y eprbj� taxes
on the residence, or has a beneficial interest in tyre taxpayer.
- FOR ASSESSOR'S USE 014LY -
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other Land
Total Land
Residential Improvements Dwelling
Garage
Total
Other Improvements
Tr'Sknprovements - Line (6) plus (7) equals (8)
11l„,eby certify the above is true, correct. and complete.
S,gmlme of Assess.,
True Cash
Value
JUN 2 3 1.989
Q Ass We r Homestead
Valuation Valua(ion
(1) _� 8o o
'1.30 _
(2) 17 0_0
5 7o
(3) tl a�ofl
/So-o
141 `' 9 6 3
i 7l 1101 /�i,
151 —_
��������ii;��
%///� %ENO
(6) °19 63
3 3 zo
(7) 81600
1 & 00
(8) i`f % �3
_ O
ACTION BY AUDI IOil -
c� I
Approved: - -. - I I:III, a-13 -8
332a
