HomeMy WebLinkAboutHomestead_Davis (32)FOflM MC 70 1979
PrturibeA By Sta�e OoarE o� ia. Commissioners
Ta Be FiIN in Ouplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�
SEE BACK FOR FILING INSTRUCTIONS
�(We) 4- �F �b�d.r� �S[�a� certify that on the 1st day of
erarch, 19��L, I, (We occup d as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being daimed: ' -
I, (We) Q'owned
❑ are buying under contract
❑ have a beneficial interest.in the taxpayer
Property Description i
Taxing District (City, Town, Township): �
Parcel Number
If buying on contract: Owners name ��� simple owner�
OO�O -bo y18
✓ �� Township
or legal description shown on tax statement:
Pt. �v����• iy-a �o l. �s �
Contract recorded in Recorders Office - Record No. Page
If any portion of the residential structure or the land, not exceeding one (t) 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
County Township
.`
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 improvements�
f`
Jt;�! 51979
Dwelling
Garage
Totai
Other Improvements � �������
7�' � ,Improvements - Lin (6) plus (7)p�ldpR($)
',�by certify the above is true. correct. and complete.
Signaiure �'f nsxssor
True Cash
Value
(�J 3o a
Assessed
Valuation
(2) /3 0 /D
(3) —G1�
�a> 9P3o
cs) —
�s� 9�30
c�> ays-a
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- ACTION BY AUDI
/70
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5-�5-Js
Datc
Homestead
Valuation
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Date: _��7%9
STATE F00.M S1569 (R'JB-09)
APPRO�'ED BY SIATE BOARD OF ACCOIJ�'T5, ?009
TRFASIJItER FOR.N TS-IAt
PRESCkIBED BY THE DEPARTME\T Oi LOGL GOVERNNE�T FTANCE If&1.11]-e_I
Indi�•iduals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beueficial, there is more incentive than ever for homestead fraud. Homestead (raud
�auses higher tas bills for all; therefore, HEA 1344-2099 requires taxpa��ers «•ho receive the homestead
standard deduction to verif�� that they are eligible to recei��e the benefit and to pro��ide additional identif��iug
information necessar}� to allow county government to better monitor homestead filings. This information
�vill be kept confdential and can only be accessed b�� authorized county officials. The Department of Local
Governmeut Finauce �vill use this information to create tools that will help county officials eliminate
homestead fraud.
�� �� �
Taxnacer \ame ProMrh' Address Sta�e Parcel \umber Lreal Descrimion:
Ralph J/ Joan Da��is R t Box 270 ?6-12-19-200-0OO.a1S-027 006-00318-00 PT NE 19 2 10 1.25
Princeron [D7;7670 AC DIO
Comp(ete and returu to:
GIBSO\ COIINTY AUD[TOR. 101 N�IAIN PRL\CETON IN 47670
�' 1
Pmb t' First AtiEE1e � Las�
`J �Q rl .JG{ �l l .
Alailing AdEress (nurtber antl sVee4 tlry, sute anE 21P coEe)
❑ Same as propeny aadress
q� aoo s�r r nc �-4-on =�J �--�
Sodal Sewnty Numbcr (lazt 5 tllplts) �nvefs License State ID NumOer (hst 5 tllBlb) sue p�lier (p¢ase spetiy in pan a belo.v)
� �
tast
�D eceased
Mailing AEdrrss (nunber antl streel tlN. �te aM ZIP mEel ❑��p � p(p��y aOCr¢ss
SodalSeciuiry NurtEer (USt 5 tllplb) Dnvets Licenu Sute ID NwrLer (USt 5 tllglts) �T^ �g ld�x W�N in Part 4 belo-x)
m
Each undersigned certifies, under penalty of peryury, that the above and foregoing infortnatlon is We and correct and that he w she is eligible to receive the
homestead standard deductlon on this property. Each undersigned also understands that, by Gaiming additional homestead deductions unlawfully, he w
she may be liable for back faues and substantlal finandal penaltles.
Ovmc 1 S�ature Date Ttleplime
,d�'.�,�; '�9/ � � ( � �
"g�aDne Date itleyime
� /
� APR o �
GIBSON �OU �'� •
NTY A� r ,,