HomeMy WebLinkAboutHomestead_Davis (29)FOFM HL 10 19�
P�¢unbetl By State BoarG o� ia. Commis5ioners
io Be FileO in Duplitate
CLAIM FOR HOMESTEAU PROPERTY TAX CREDIT FOR YEAR 19 �q
SEE BACK FOR FILING INSTRUCTIONS
�(We) ��ca�.�l.AL `+�' �-��-+�^-+ � certify that on the 1st day of
.�arch, 19� 1,4(We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I. (We) C�'owned /\O / _ ' �D 11 � �
❑ are buying under contrac[ v �� ��
❑ have a beneficial interest in the taxpayer
Property Description in Xk—�.�d.CN�J
Taxing District (City, Town, Township):
Parcel Number
If buying Ofl contract: Owners name ��� z�mo�e m.ne.1
nty `���� Township
or legal description shown on tax statement:
PE. sE�i� i9-�-io �P. ��/4
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.
��� � �_ � . ��
Sveet Aetlreu
Counry
Township
Q�y. Sta:e anU ZIO
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 -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
Total Land
Residential Improvemen� �
� � �elling
Garage
j�N G � ts7� Total
Other Improvements
To�°' -Improvements - Li )
`,�iy certify the ab is,
�x,�� _
s e als )
c rrec . n complete.
AUDITOR
True Cash
Value
(t ). .SO o
�2� h�6 4�
rs� ��9 0
�a� S3 5/a
f5)
(6) 53 �a
(7) a3 Sa
�g� �J69U
�.�n•r.�:����u•,.�
Assessed Homestead
Valuation Valuation
�—
�
S-a S- � f
oa:e - - -
Date: �- .Z-� ? �
SfATE FORM U569 (R:J8-09)
APPROVED BY STAiE BOARD OF ACCOWTS,?009
TREASURER FORAf 1S-IAI
PRESCRIBED 6Y THE DEPARTMEhT OF IACAL GOt'ER,I:NEYi FT,'p�CE IC61.1 �+$.I
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more incentive thao ever for homestead fraud. Homestead fraud
�auses higher tas bills for all; therefore, HEA 1344-2099 requires taspa��ers ��•ho receive the homestead
standard deduction to verify that they are eli�ible to recei��e the benefit and to provide additional identifping
information necessary to allow county government to better monitor homestead filings. This information
�cill be kept contidential and can only be accessed by authorized county officials. The Department of Local
Go��erument Finance will use this iuformatiou to create tools that «�ill help county of6cials eliminate
Tama.er Ysme
Cah�in L Davis
Complete mid return !o:
�,
�iA� v/%�
ProMm' Addrtas
RI Box 268
Princemn IN 47670
homestead fraud.
Slarc Parcel Sumbcr
26- I 2-19�00-0OOA32-027
Nr' �
GIBSON COIJNTY AUDITOR, 101 N M,UN PRINCETON IN 47670
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Firs1
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Firsi
Afailing AEEress (n�nter aeM streeL a�Y. sute and ZIP mde) -�
��� �. ���5. �ii /�/c� !�OGb/
Orivefs License State ID
A4AEle
�������
LeealDescriotion:
006-0P732-00 PT SE 19 2 10 3.00
0.10
�� ��S
°°• � ancw�sceaninPan<wJa.)
A40Be
Same as papeny aENess
� �%��U
Sw � Ol�er (pease soedry in Pan a Oelow)
Each untlersigned certifies, untler penalty of pe�ury, that Ne above ana foregoing Iniormauon is we antl covect antl tnat ne or sne is eugmie ro recerve i
homestead standard deduction on this property. Each undersigned also understands that, by Gaiming additional homestead deductions unlawfully, he or
she may be liable for back taxes and subsfantial finandal penaities.
O.mer 1 Sipanue
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Date
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