Homestead_Adkins (2)i
C IM FOR HOMESTEAD PROPERTY TAX
._ ANDARD /SUPPLEMENTAL DEDUCTION
fate Form 5473 (R1216-09)
resrtibad by the Departmand of Loral Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
l
I (We) (,% /0� (V adA Ad]C , 4s certify that I (we) ocafoied as my (our) principal
place of residence or am (are) buying e o owing escribed real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of riling):
[:11 (We) own ❑ Am (are) buying under recorded contract
❑ Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
INFORMATION
N e of da'unant (legal name)
Q
a�0 Ua -_
Social Security rsm6c of claimant (last five digits)
Divers license I Identification f Other number
Iswing Some
/.. /
of " )
Name of claimant's spouse (legal name)
Social Seemly number of claimant's spouse (last five digits)
Drivers ficense I Identification I Other number Issuing Sate
of claimant's spouse (last five dlgds)
CONTRACT •••
If buying on contract Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY
County
Town ip
Taxing district (city, town, township)
Parcel number
Legal scriDtion
Is the property in question:
0 -27- 0 -;003 S/ �"0!
a 0
eel property El Annually assessed mobile tome (IC &1.1 -7)
If any portion of the residential smrctrlro or the land not exceeding one (1) acre that immediately surtounds that structure Is used to produce income, describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT
IN OTHER COUNTIES
County Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
Address
�CJ
CamVALUE
ASSESSOR USE . ONLY TRUE TAX ASSESSED VALUE 1, HOMESTEAD,
AT tr'. OF TTV I VALUE VALUE
Land not exceeding 1 (one) acre immediately T,-;; .ry„s}5 f Yet ?
surrounding residential improvements. (1)
Other land
(2)
Total land (line 1 plus line 2)
(3)
-
Dwelling
(4)
y�x'�rt_- 'a
'..4
Residential improvements or Annually
}3�- -%'Lg
- -
Garage
'Y ? 3 A
Assessed Mobile I Manufactured Home
Other improvements
(6)
Total Improvements (line 4 through line b)
(7)
Total value (line 3 pis line 7)
(8)
I hereby certify the above is true, correct,
Signature of Assessor
Data signed (month, day, year)
and complete.
Verifying action - Signature of Auditer Date signed (month, day, year)
® -•
•. DEDUCTION ALLOWANCE'
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
NohviNstandirg any otherprovision, the sum of the deductions provided in IC 6-1.1 -12 fo a mobde home that is S
rot assessed as real property or to a manufactured home that is rat assessed as coal property may not exceed
ome haa(1/2) of the assessed value of the mobile home or manufactured home.
Signature of Auditor
Date signed (month, day, year)
RATE num: t./du/f-,} masons PoRN ZU`
ArFMn'EO BY STATE BOARD tf ARODUNT:.2n. PAI:%Tlam BY nlr DEPARTMENT. Of Ix sIr.wrLNMrKrmeANCE M.-I.I-r4I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
• PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than net for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
HEA 1341-2000 requirts 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
filings.This information will he kept confidential and can only he accessed by atohorized county officials.The Depanmem of
Local Government Finance will use this information to create tools that will help county ty officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Adkins, Harold Quade 611
a GIRO RD
Ilazleton IN 47640
72
Harold Quade Adkins
2597E Giro Rd State Parcel Number Legal Description
HAZLETON IN 47640-9300
III I III I I I I I I I I I I I III 26-02-27-200-003.517-017 009-00069-00 PT LOC 1 FR/PT LOC 6 FR
r u ut t ur a nr t 1m t ur ur t te nt ur 27-1-1011.92 AC
PART 2:TAXPAYER INFORMATION
Owner I First Middle /� Last
tie'R-0U) QUA-DE • AD S
•!S Address—(number—ariaa street;city,irate,and ZIP code) Msmn.L prupenv uddreas - -- — - - - - -
—
Spouse First Middle Last
Mailiac Address(Number and street city,slate,and ZIP code) Same as property address
Social Security Number(last S digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
Sole
PART 3:CERTIFICATION
Each undersismed 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 acliundersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes• substantial financial penalties.
Owner I • re Date
po - ignamre Date Telephone r l
PART 4:ADDITIONAL INFORMATION
•