Homestead_Simon ' • STATE FORM r'MIR-'/•-YI TREASURER FORM i}IA
.APPROVED BY SLATE BnV)OF ARSi%TS am PRIMED BY Tilt BEPAMTQTtT Or LOCAL CAwm0.9NEAT FDAS'CE IC 6-1.1-22-$.1
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 cm for homestead fraud.Ilontestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires axpasen 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
flints_this information will he kept confidential and on only be accessed by authnrited county nflicials.The Ikpanmtrnt 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
Simon, Danny A/Judy A
R2 Box 61 A Q
Ilaubsadt IN 47639
8372
Danny A/Judy A Simon
10229 S 350E _ _ — State-Parcel,Number— Leval-Description
_ __ _Haubstadt.IN47639-7875 -- — - —
lll 26-19-34-400-000.912-024 004-00912-00 PT SE 343101.275 AC
n��nt�l��nn��l�l�n�ru��n�t�nr�r�r�nr�r��r�trr r��r�
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PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
D1IJIt13 R -S, mon
�tg Address(number and street,city,state,and ZIP code) Lea Same as property°ddtcss -
/o4a9 S -330 t 2-lauLs *e4t- _T N 92439 - 7625
Tfltcky A _ 5; m0 n
Mailing Address(Number and street,city,sate.and ZIP code) J 2 Same as properly address -
10 as 9_ S - .-15;? G . /H:4.9sa;,4L/- N 9 ,6_19 7 8 ?s
--'
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
FOflM HC 10 1979
ReuriCeE By State Bwrd of 7az Commissioners
To & FileG in Dupliwte
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT FOR YEAR 19��
SEE BACK FOR FILING INSTRUCTIONS
;�(We)�-�/� ,�� /-�- �'�' �- certify that on the 1st day of
arch, 19��, I, (We) occupied as principal p ce of r idence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract _�/ _/n
❑ have a beneficial interest in the taxpayer ���� 7
Property Description in d ��-a
Taxing District (6ity,-Tswn, Township):
Parcel Number
If buying on contract: Owners
%� a�
Township
or legal description show� on tax statement:
�' s'E /� � s� 3-� � . 9i 3 a�'t2_
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.
� cf�nm�.f ��,(�a2B.v — /��_ �ie1
s - a 9-79
County
Township
`�76 3 �
ZiP �e
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 -
� � � � � True Cash
Value
Land not exceeding 1(one) acre imp�e�ijaFel� io79
surroundinq residential improvements�'
Other Land �� /�/L`� �
Total Lantl :d��l
Residential Improvements f �UD+TOR
we hng
Ga ar ge
Total
Other Improvements
To' Improvements
I ��ay certiiy �he
` / )_
SigeyWre
Line (6) plus (7) equals (8)
above is true. correct. and complete.
Approved: � `
(i) So 0
(2) —
(3) S`O O
�a> � s�sz o
(5) —
(6) �.5`5 a,0
(�) � 0
(g � � S'�-�°G
� lo U °I o
" - ACTION BY AUDITOR -
` ��c,C,P�o �� +
r-----
Assessed
Valuation
�
/7t7
Homestead
Valuation
�
_$ ��'° �z 6 � o
s =� s�- 7 y
Dare
Date: s�°��� / 7