HomeMy WebLinkAboutHomestead_Boxell Investment IncFOflM HC 70 7979 To & Filed in Duplicate
HescriEW By State BoarC o� Tax Commiuioners
CLAIM FOR HOMESTEAD PROPEATY TAX CREUIT FOR YEAR ly�[.�; ---
SEE BACK FOR FILING INSTRUCTIONS
�(We) certify that on the 1st day of
arch, 19� I, We) occupied as our rincipal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: �
I, (We) C�owned ��c� - bol 9D -�
❑ are buying under contract
❑ have a beneficial inter�e/st �in the taxpayer ' �n
Property Description in �sCL�-U-d.c�,.� County '�"��� Township
Taxing District (City, Town, Township): ��-��-� �'�-«�
Parcel Number or legal description shown on tax statement: �
`�E . d�o-c. a/� �-/ c S 6. G 6 /�
If buying on contract: Owners
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 incom�,�scribe the use and por�iqn�f the properJ�y uti�zgd to produce income
Any other courities in which individual owns or is buying real property:
�
e, correct and complete.
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County
/ /G i y�_F!
Township
y� �d-��!'. S/�
Ciry. State anG Zi0 �e
�s buying under a contract that provides he is to pay the property taxes
residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY - �
Land not exceeding 1(one) acre immediately
surrounding resideT�ial �npro�ments� �
m �
Other Lantl d d
Total Land
Residential Improvements� �`� % v 1y7�
Dwelling
. �,�1�� Garage
,//,�� Total
Other Improvemenis v „UDITOR
T�'-' improvements - Line (6) plus (7) equals (8)
I�oy certity the above is true. correct. and complete.
Sig�awre ol
Approved
True Cash
Value
(�) Soo
(2) �'�{7 7 0
(3) .5�7 O
(a) /� 5 2 0
(5) —
�s� las��
(7) 0�40 0
�s� I �9 a o
Assessed Homestead
Valuation Valuation
_-'i
���
7! �9 0
5- �-�-� r
Oa:e
Date:
SfATE FOR.\fi3569(RlB-10)
TRF�SUItE0. iOk�t TS-IA
.1PPR0�'FD BY SfATE BOAND OF ACC017�T5. _'009 PRESCRIBFD BY THE DEPART\fE\'i OF LOCAL GO\'EA\1fE.\T FI\p.�CE IC61.1-'_?-8.1
��v �0° � � U D'°�� ° � °
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more incenti��e than ever for homestead fraud. Homestead fraud
�auses higher tas bills for all; therefore, HEA 1344-2009 requires taxpayers «�ho receive the homestead
endard deduction to verify that they are eligible to recei��e the benefit and to provide additional identif��ing
information necessar}� to allow county government to better monitor homestead filings. This inforniation
will be kept confidential and can only be accessed b�� authorized county officials. The Department of Local
Go��ernment Finance will use this information to create tools that will help counh� officials eliminate
homestead fraud.
- (r�'Y�.I{l8 `CFi.ioxiL?T;31t57[�.`C7Llo',.�``iL�J`U�a�`J
TawarerSame Pronem'AdArecs StateParcel\'umber LeealDescrintion:
Boxelllnvestmentlnc B�LDHILLRD ?6-Oi-40-211-000.190-027 PTLOC211 110 i6.66AC
PRINCETON W 47670 C_�
Comp(e�e and re(urn to: � ���������Q�������DD�d��������������������0
CIBSON COUNTI' AUDITOR, IOI N D7AIN PRIA'CETON IN 47670
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pwner t Fvst - MiGd1e Last
. Os«L �
Madu�g AtlCrass (num0er aM sVeat, �, state erM ZIP caEe) Sama as property eaEress
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MaAVg AtlNess (rnvnbar anC 57ee�, ciry, sta:e a�M ZIP cotle) ❑ Same as propehy atlEress
Socisl SeaaLLy Nvnber�last 5 diglts) Deivers LicensMSate ID NumEer (last 5 dlgitz) sme 0'.tiat (please specdy in Part 4 pelow)
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Each undersigned certifies, under penalty of perjury, that the above and foregoing information is W e and wrrect 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.
Owror 1 Sqna:ure Da:e � Telephorn
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Spouae 5igna:ve Dna �r� Teleplime
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