Homestead_AdkinsCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION'
State Form 5473 (R2 / 5-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC70
1"-w-
CERTIFIC % STATEMENT -
I (We) - certify that on the 1�Arf�alch7.]gU_
which
I (We) occupied as our principal place of residence the following described real property for a Homestead Property Tax Cr h vAi' alr�nl�
❑ 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 gtjnyiugynn`�e. r
/O
GISSON UNTY AUDITOR
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
FPaf.cel
Township
Taxing district fary own, I s ip)
number
Lega escn
d
- 9 oa
o C_ C) o? 7-/-/D
11 any porti n of the residential structure or the land not exceeding one (1) acre that immediately surybunds that structure is used to produce uxtorne, describe the use and portion of
the property utilized to produce income.
_ - PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
Signature of clai
�lereby certify the above statements are true, correct and complete.
�t
A ress (number and street, city, state, ZIP code)
4740
L a .
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Otherland
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certity the above is true, correct, and
Signature of Assesor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
$
aluation or $2,000
Sig
tur f Auditor
d
Date signed
SLUE ffRN!)'M nCf54 t MAS3RFA MIN n-IA
.Ar•xrw'En BY RATE BMRD MMYt*'.nit•Sew PRffWDWDY IDr DEPARner OF LOCAL GOVet`'sliwr MANCE M 4IJ-r4 I
Gibson County Auditor
1C1 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead,tandanl deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than eser for homestead fraud.homestead fraud causes higher tax bills for alb therefore.
* FILE [ HEA 1144-2009 nt to requires taxpayers who receive the homestead standard deduction to verify that they are eligible to remise the
(, benefit and to provide additional identifying informaton nemarY to allow county government to better monitor homestead
j tiling,.This information will be cep confidential and can only he accessed by:uthar ed county officials.The Department of
Local Government Finance will use this information to create nwrls that will help county officials eliminate homestead fraud.
APR 1 9 ZU1U PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
777 fe/
? Adkins, Harold L/Mabel M
GIBSON OUNTY AUDITOR • 2601 [Giro Rd
Ilaeleton IN 47640
67
Harold L/Mabel M Adkins
2601 E Giro Rd
Hazleton IN 47640-9301 State Parcel Number Legal Description
!_„ r1_t r__r , , r_ 26-02-27-200-000.069-017 009-00069-00 PT LOC 1 FR/PT LOC 6 FR
- hlul�tT�i�hn lrtll�ltt Iillllllllllunnitl�- - ��fli�il — --27-1-10 13:74-AC— -- ___ ——
V
. PART 2:TAXPAYER INFORMATION •
Owner I First Middle Last
/-12.,"/-12.," a /oi p r 4alteiXS
•tc Address(number mid strett,cifv.state,and-ZIP code) — __ _ __ _ ___ }a{inn n,property addles; — - - .—. . —
/
Spouse First n Middle i M>7 s Last
Mailht;;Address(Number and street,city,state,and ZIP code) LJ�ame as property address
9
z-
• PART 3:CERTIFICATION
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 financial penalties.
Owner ISiSignature Date
PART 4:ADDITIONAL INFORMATION