Homestead_Adamso ..nn . CLAIM FOR - HOMESTEAD PROPERTY TAX
a° 4' CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/1 -90)
.• '° ° P INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT a
FORM YEAR
HC10 I
6 . m 1 � �n.i�%
(.dMi7yLlh�at on the 1 st da f March,. I
Oroberty � )occupied as otN pr�i ipal pl e of re dencethef owing described real property for w Ali ®K I lead
�. Tax Credit is hereby claimed: I (We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the
property or isbuying it under a contract.
CONTRACT RECORDED
If buying on, contract, Fee Simple Owner's Name
Recorder's office where contract is recorded - Record Number Page-'
PROPERTY DESCRIPTION
Con Township I Tax' strict (City, tow , township)
r Number Le I Descri Con
If any portion of the residential structure or the land not exceeding one,(1) acre that immediately surrounds that struc-
ture is used to produce income describe the use and portion of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
ASSESSOR USE ONLY TRUE TAX VALUE , ASSESSED VALUE HOMESTEAD VALUE . NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Otherland
Total land - line (1) plus line (2)
Residential improvements - Dwelling
Garage
Other improvements
Total improvements - line (4) through line (6)
Total value - line (3) plus line (7)
11)
1991 Pay 1992
19 —Pay 19 —
_,sser of 1/2 Homestead
(2)
Lesser of 112 Homestead
Lesser of 112 Homestead
Valuation or $2,500
(3)
Valuation or $1,500
Valuation or S1,500
rsignature
(4)
•- —
-- -
- - -
(5)
(6)
(7)
(8)
1 hereby certify the above is true,
correct, and complete
Signature of Assesor
Date Signed
Verifying Action - Signature of Auditor
Date Signed
STANDARD DEDUCTION ALLOWANCE
1989 Pay 1990
1990 Pay 1991
1991 Pay 1992
19 —Pay 19 —
_,sser of 1/2 Homestead
Lesser of 112 Homestead
Lesser of 112 Homestead
Lesser of 112 Homestead
Valuation or $2,500
Valuation or $2,000
Valuation or $1,500
Valuation or S1,500
rsignature
of Auditor
Date igned
STATE FORM 53369 tt3 I8-.IO) 15555U'RE FORM 13-IA
APPROVED BY STATE BOARD OF ACCOUNTS.X09 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC 61.1-224.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street °Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore,
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
:) benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
Si FILED filings.This information will be kept confidential and can only be accessed by authorized county officials.The Department of
rLy le J/ Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
- APR 14 2011 Taxpayer Name - Location Address
- - _- -- A.-
- —� - - –= ---- - Adams,TommyJ-/-JenniferL-�_.— •- -__, –
407 WOOD
GIBSON COUNTY AUDITOR FRANCISCO IN 47649
4637 ,11011 I L III I Ill Ill vi ii 01111111111111111II 1111111011 _11 [Tommy J I Jennifer L Adams
PO Box 123 0
Francisco IN 47649-0123 .,
1"1111111111'11'1111111111111111111111111111111"1"1111111111 State Parcel Number - Legal Description
26-13-20-101-000.143-005/T NW 20 2 9.28 AC
5
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.
—_ 1_______ PART 2: TAXPAYER INFORSMATIO_ _
Ov. I First Middle y'� Last
•Mailing Address(Limber and street,city,state,and ZIP code) al Same as property address
42011 F . W oo0 Sr .
Spouse 7 First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) I.;r,I.Same as property address
uk of c . \.J000 s"y °Iv
, •
PART 3: CERTIFICATION r"
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
unlawfully,he or she may be liable for back taxes and substantial firiancial penalties. - - • • -- - -
Owner I Signature
_ � Date l