Homestead_Adams (3) STATE'.FORM 53569(R3t5-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC61.1--2222-9.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
'�duction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
.pauses 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 filings. This information
will be kept confidential and can only be accessed by authorized county officials. The Department of Local
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
• - PARTI: P'OPER Y:INEORMA ION q;-
Tasparer Name p roperty Address State Parcel Number Lem!Description:
Rick Adams 6361 S SR 165 26-17-09-300-OOI.275-021 PT SE SW 9 3 12 1.65 AC
OWENSVILLE IN 47665 D-I6-20 •
complete and return to: IN11111OhltlLI011111 f lU f113tIFO]Mlmf011111IIIIVII
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
Owner 1 First Middle Last
R-1 Lee Adams
Mailing Address(mapoer and street,city,state and ZIP rode) I I Same as progeny address
Spouse First Middle Last
e n,t 1-y nn earns
Marling Address(member and street,city,state and ZIP code)
ba.$ame as=party address
,
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to receive the
homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions unlawfully,he or
she may be liable for back taxes and substantial financial penalties.
Ownner>>Signature Date
•,•:
FILED
NOV 13 2012
Ut ibUN tsOutITY AUDITOR
t•:
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT / STANDARD DEDUCTION
iState Form 5473 (R5/ 10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
..CERTIFICATION TIFICAT10N sTATIEMEXT �:tt$
FORM YEAR
I (We) I I—L �� :�!� ,r � rcertify 6at onihe 1st day of March, 20
n e bed real property for whict(a146r�esti — I
I (We) occupied as our principal following described iac�,`Pro�e�yTax.Cle`dit is•h'ereby claimed:
nil (We) owned ❑ Are buying under contract
K.3ve a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONT RACT! R ECO RD ED -ft'
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Record number Page
DESCRIPTION
Z PROPERTY,
Township
County
Township
Taxing distrkc y, n, to nship)
Parcel number
6 /Cp 75 -cx)
9-3
Is the property in question: IV
I ❑ ❑
(00 -0
--,,( n m r and street, af;�7 cad
to t, / 11' 1/-j Al
-/CZ
Real property MOW12.. (I .0 6- 1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that i that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
7eg 5yptnds
v �
It' WAr� P Ronkt�bm E 6 BY-CEkl hf4WT- I k bTH ER"COUNT11 E§ h
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Si u • a claims I
--,,( n m r and street, af;�7 cad
to t, / 11' 1/-j Al
76 J-
g�,.�-!" STANDARb�DEDUCTlONALLOWANCE��-e�a?P,.*;,J��,"�,�.I
WNW 20 _ Pay 20
Lesser of 1/2 Homestead
V n or $6.000 S
Tatio
Date sioned
-TAX
f�..TRLIE-
ASSESSED VALUE
t'%;HOMESTEAD -z
�rj'„r� 'NZN'Ikii[131�h 14L"L''�--,
M�' If"'VALLJE;�:
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (fine I plus line 2)
(3)
Dwelling
4s
(4)
Residential improvements
Garage
(5)
MMrfAv
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
1
Signature of Assessor
Date signed
complete.
I
Verifying action - Signature of Auditor
Date signed
g�,.�-!" STANDARb�DEDUCTlONALLOWANCE��-e�a?P,.*;,J��,"�,�.I
WNW 20 _ Pay 20
Lesser of 1/2 Homestead
V n or $6.000 S
Tatio
Date sioned