Homestead_Adams (4) • MUTE[ORM!TW time/!W I mm£Asummm FO,31 71-IA
nrPROVED BY STtTE WARD Of ACCOUNT C.aov PRI4ABm BY ME OFPARTIEYT OF LOCAL IXn20.YMrKr MC:ANCE IC 6-1.14:4,1
Gibson County Auditor A
101 N Main • IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple.are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than e'er for homestead fraud homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2000 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifyine information necessary to allow county government to better monitor homestead
fihinta.This information will be kept confidential and can only be aceecad by authorized county officials.The Depannlent of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY LNFORMATION
Taxpayer Name Property Address
Adams, Jerry W/Lois J
1701 Cottonwood
Princeton IN 47670
699
Jerry W Adams
1701 Cottonwood Dr State Parcel Number Legal Description
PRINCETON IN 47670-3325
Ir�rr��trt ltl�trI r ttlll lltrtlltttltlrltltII
11,11111 26-12-06-401-000.845-028 019-00845-00 NORTHBROOK HILLS 42
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2:TAXPAYER 1NFOR)1ATION •.
Owner I First Middle Last
J
err iJend rei( 40kLF1/415
afrg Address(number and street,city,21 te,and ZIP code) Same as property address
Spouse First Middle Last
Lois - eckw,_ Aciaiwt
Mailing Address(Number and street,city,state,and ZIP code) I v,Same as property address
--
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct 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
unto ly,he or she may be liable for back taxes and substantial financial penalties.
I Stignature Date
0
�:} CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
/ State Fortn 5473 (R6I1-03)
Prescribed by ihe DeOartment of Local GovemmeN Fnance
INSTRUCTIONS: See revcrse side lo�liling inslrucfions.
FORM
HC10
YEAR
I (We) ��� / � � / � C���`" � `''�1 � � � � `�� � , • certi(y ihat on the 7st day of March, 20
I(We) occupied as our principal place of residence th following described real property for which a Homestead Property T�c Credit is hereby� ed:
❑ I(VJe) owned ❑ Are buying under contract ��� �,
, Have a benefidal interest in the enGry that is liable for the property taxes on the property and that owns lhe property or is buying under a wnVaU.
If byv�g on conuaG, Fee Simple owners name
Remrders office where conVaG is recorCed
a-�-..y� 7;;u as: y ' . -4,�„"�-
i3�ar,..,-,�.�7.t.a,�T"-er�t�.��tf.�#.�cri�'�..r�.x'��g�, -�-w'�P.`-�w:�`zP,RI
Counry � Tamship
7i�Sas✓ fiiv/��
Parcelyymber � rj ��, Legal description
If any
of ihe
County
ta�.
Is the
— UUQ i"J '?X� � � L�� wovem ❑�a�e Homo (I.C. 6f.7-�
m of Ne residenUal sWCWre or Ihe land not exceeding one (1) ave that immedialey wnounds that sWdure is used lo produce income, tlescriba the use and poNon
erty utllized to produce inwme.
Tawnship
I hereby certify the above statements are We, covect and complete.
(num rarMs6eel,ary,sfate,ZlPCOde)
I I `oTnti\ L.1r,�» ��
f/I
�"�� ��""`�"'r�"� �.,���'�"�'� �+�'TRUETWC�����` ASSESSEDVALUE �HOMESTE/1D'�''�� NON;RESI�ENTIAL �Ga
��'-ASSESSOR USE ON� Y��f� �'yr t ��' �
�-�- � .o .i�;'.AtiFo-u'�ifa.'�.�."'s.�.-4�L'�-� i�t�#VAI:UE.��� �.ATw100%u� ��.�.FC"..�t-t:VALUE��,� �,`�����..VALUE� .'�.345�
Land nol exceeding 1(one) acre immediatety F�," �,���;;rt'�"��� �
surrounding residen6al Improvements. (� � •�' ���`' #"��"ra�...,;,� rHt<<
� � � .
Other land �Z) �`.���,y��i;a �a }
:,.5 �.ss �'�
TUaI land (line 7 plus line 2) (3)
�,.. <f "" ,� ���c7•�•�. ��
Dwellin 4 4- `?'
ResidentiallmprovementsorMnually 9 (' �''�`'�����Y�'�`��
Ass�ed MobOa / Manufac�red Hama Ga2 e ����""� �x s� '" �s�
9 (5� ��;,''��,��_+���s��'�`-i-s='
�.��
��A �1.
Other improvements (6) ,P-z��
' �:... _ -�rc :r_
Tctal improvements (line 4 th/ough line 6) (7�
Total value (line 3 phs line n (g�
I hereby Gertify the above i5 We, coned, and Signature o(Assessor Date signetl
complete.
VrrifyNg action - SignaNre of PudiWr Oate signeE
��