HomeMy WebLinkAboutHomestead_Blair (3)FOflM HL 10 19i9
fieu�i�eC By Staie Bw�O ol ia. Cammissioners
io Be FiIN in OuD���ate
CLAIM fOR HOMESTEAO PROPERTY TAX CREOIT FOR YEAR 19 ��
SEE BACK FOR FILING INSTRUCTIONS
'�(We) /��^', �O�-��-�� E��-� certify that on the tst day of
March, 19� L, I, (We) occupi as o principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) � owned
are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in ��en� County
Taxing District (SiFy—Tewn, Township):
Parcel Number
If buying Ofl contract: Owners name ��� simo�e owner�
�jQ(� -DD/(o(�'00
Township
or legal description shown on tax statement:
�- . �CIE �.� . �t� .�i - i - iv S, 7 % �.
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: County Township
�hereby certify the above statement is true, correct and complete.
� . � : , s � ,, i o l? �....� �f % d ' D
naWrN ^� SVret ACare55 Giry. State ana Lp Coae
tJ'il N
` 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
Lantl not exceeding 1(one) acre immediatel ♦
surrounding residential improvements �� i �i �) Soo
Other Land � L (2) 3 So
Total �and MAY 11 ��°� (3) • 8 So
Residential Improvements � /58 90
. ��t�Q� cs� —
Total (s> /S 8 90
Other Improvements SkE� (7) a 90
T��Improvements - Line (6) plus (7) equals (8) �g) / r� 8 0
I�,._,e6y certify the above is true. correct. and complete.
SigtNWre ol As5es50e
����1����
Approved
Assessed
Valuation
/ 7'0
J�f-6'�
Homesiead
Valuation
�—z—�i
oa,e
Date:
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Gibson County Auditor
101 N Main
• PRI��1�7� �
APR 1 9 zUw
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OI830N COUNTY AU01T0�
�
InJiriduaL.� anJ �n�,-rieJ aoupks are limi�nl m nrc homcuesJ �tandtN J;Uu.�ion. As thc raceipt ol �his JcducCwn Fccomes
mure beneficial, therc is morc inrentnx thm ecer (or humesmacl Gaud IlomesteaJ ftaud wuses highrr tax bills fur.11; thertfae.
HEA 1333-NN19 requims uapa.m v:ho r.�ceirc ihe tu�nesi.aJ sianda�J d3fuction m.eril'y dwt the; me cliciMe w reaci.e �h.
brnefit aN to p�w�ide akiitional idemiiyinc inWrmatiw mcr+san� io allw' eounrc ememmmt �o betrcr mmimr homrne:al
filit�. Thic infomu�inn x�ill M AryM ctmlidcrvial anA �n nnly M� arcez.eJ 6y amMrize�l counh' olTicinlx. "fhe Ikpannrcm af
1_ocal Gmcmm<m Firunce will usc this iniortnaeion tu arcam twls �hat will hcln counn� oficiat. diminne hexncmaJ fiaud.
Patricia Blair
321 E Old Petersburg Rd
PRINCETON IN 47670-8515
�i�n��iu�i��u�iu���n��n�n�i�nn����i�ni���n�����u��
Taspa��er Name
Blair, Patricia
State Parcel Number
26-05-31-200-000/166-027
J
Prnnerh' Address
3? 1 G OLD PL•TI3RS13URG RD
Princeton IN 47670
Leeal Description
006-00166-00 PT NE FR 37 1 10 5.77 AC
C-1
,. ,
Ouna I First Afiddle Last
p- , � her i2
�g Address (number m�d svec4 niy. state. and'LIP cone) — - . ..'---- - - ' - � � '- — � �-Smucu.propcny mIJ�' ' - - .
3 i r�NCero�✓ iNd �1.70
Socul Security Numbcr (last 5 digi�s) Ihivers L' <nse/Sute ID Nmnba Qast 5 di:its) O�her (pleuc sptcify in Part 4 6elow)
Middlc Last
Mailing Addrrss (Number anJ Ar<e4 cin, s�a�c. and'GIP cuJe) � Sam< ai pmperty addres�
Social Stturity Numbcr (lan 5 digits) Drivcrs Liccnsc/Sta[c ID Numbcr Qast 5 digits) Otha (plcacc spcciH in Pan 4 bclow)
Snr
� � . �
Fach undersigned certifies, under penalty of perjury, that the above and forepoing infortnation is we and comect and that he or she is eligible to
receive the homesiead standard deduction on this property. Facfi undersigned also undersmnds that, by claimine addiiional homestead deductions
unlawfully, he or she may be liable for back taxes and subsiantial financial penal[ies.
O�.ner 1 SiEmaWre Ihtc Telephone
Spou;e Sip�ature ��c Telephonc
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