HomeMy WebLinkAboutHomestead_CloinFORM HC 10 1979 ! ` To Be Filea in Duplicate
PrescribeA By State Boara al ia, Commissioners �
!
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT fOR YEAR 19�
SEE BACK FOR FILING INSTRUCTIONS
�(We) `�'�-�� �� `f' � � certify that on the 1st day of
�tarch, 19�2, I, (We) occupied 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 95D/_ „DQ ?...i� - /,��
❑ are buying under contract �J �U J �J
❑ have a beneficial interest in the taxpayer /�
Property Description in .�J-�--<l�d�^� County `��� Township
Taxing District (City, Town, Township): `d"'��a- �.
Parcel Number or legal description shown on tax statement:
Pt. w'ia NE �s� Trc...c.t a.f� is-� io `f,.3q�
If buying Ofl contract: Owners name ��� simoie owner�
Contract recorded in Recorders Office - Record
If any portion of the residentiai 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.
�, n . _ .
County
Township
Sta:e ano Zip Cpae
' 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 Assessed Homestead
� p � Value Valuation Valuation
Land not exceeding 1(on�ac im���iat
surrounding residential improvements � (�l 50o i� ���
Other Land _��N 1 � �g7g
Total Land
Residential Improvements,y� welling
(/�, i
AUDiTOR rage
Total
Other Improvements
��7'�� improvements - Line (6) plus p) equals (8)
aby certify the above is true. correct. and complete.
Syruture �9 Assessor
(2) —
(3) 500
(4) �ioSSo
(5) —
(6) �(i55o
(�l —
(8) �GSvro
- ACTION BY AUDITOR -
Approved: � �
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Date:—l�f �/7�-
9
Gibson County Auditor
101 N Main
PRINCETON IN 47670
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tl\iE Il1RN �! W IM=/f WI
.11�X(�.'fl� XY tl�IE MUpM Y«A:\Tl_ 9w
REVNAfAff10.V YIA
InJi��iduaK and rrtvtint <ouple: a�e IimiteJ io nm hom�caJ �tandaN JNuction. A� �he receip� of thi� Jedurtian beconxm
murc 6cnencial, thrre is morc incenmr dun ncr (or homn7esl Baud Ham�eml f`aW caiues highrr ta� bilL fw ail: thercfar.
HEA li�l-i-3009 rcquim uxpa.ers xho r.miae ihe hwnestcaJ siandarJ JNunion N.erilv iMt they ore elicide to meei�e ihe
brnent aml tu p�rn'iUc ukliiio�ul idrntilyine inturmanon rinrsvn io aliw' counn' garmmeni ro be�mr mmiror humrs�eaJ
filint,.�. Iliis infamwim will M Aryu audiJemial anA r.in only k� arm�uA hy aWhnrirN rmnuy olTicialz 7he Ucpanmem nf
LueW Gwcmmeni Fi`unce eill ux �his inioema:ion w creaer twls tha� aill h;Ip cwm� ufficial� eliminarc homcstead iruud.
• • , , , , .
Taxnaver N•ame Prnpert�� AJdress
Cloin, RobeR H/ Patsy L
R ? 13ox ?65-a
Princeton IN;7670
Robert H/ Patsy L Cloin
679 S Curtice Lane
PrincetonlN 47670-8864
— - ---- -----
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S[ate Parcel NumAer
"-- --zs=iz-iszoa000:sss-oz�
V
_Leeal Descriotion_ . __ � _
006-00335-00 PT E NE TRACT 2A 75 2 10
4.3923 AC C-1 "
1' �
ON�ner I �n��� First � Middlc ���� l.ut
g Address (numbcr mid >vcec ciry, succ, and ZIP codc) � . � Same as praperry oddma; -� - �— ' -
��y s ��� �. �.������v�� ��G�a
Social Securily Number (last 5 digiLS) Driver's Litt�ue/State ID Nmnbcr (lazi 5 di�iB) Other (pl�ue spaify in Pan 4 below)
��
Spoucc Fim Middle ��� Lut
�'i�TSY � �
Mailing AddreSS (Number and slree4 ciq', slale, and ZII' w�k) S:une u pmyertr addres
-- � -- s, �U���:_�-_�pr,�-���r _���7� =----- ----
Sorial Stturin� Numbtt (lan 5 digits) Dm�crs LiccnscJStatc ID Numbcr (la t 5 digits) Othcr (plcasc spccify in Pan 4 bclow�)
.�
.. . ,
Each undersigned certifies, under penalty of pequp•, that the abo��e and foregoing informatiun is we and co�rect and that he or she is elieible to
receive the homes�ead standard deduction on this propeny. Each undersiened al;o understands ihat, by claiming additional homestead deductions
unlawfully, he or she may be liable (or 6ack taxes and substantial financial penalties.
Ow�rcr I Si�,manne%/��� C/%;''2 _ Ua�: / 7'clephonc ���
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