Homestead_Adams (2) MATE FORM'Mt.ire/W+1 1RFAVI RLT 10101 73-1A
APPROVED BY flat.IMRo Or MYVa\ta,b+ PILISCRIBED BY Ow OFPAFTMLYrt*LOCAL tMER.MMQ.'T FINANCE IC VI.I-gal
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individual and married couples are limited to one homestead uandani deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ever for homestead fraud.Homestead fraud causes higher tat bills for all:therefore.
HE.\ 1344-2009 requires laapayers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information necessan'to allow county government to better monitor homestead
filintvs.Iltia information will be ken confidential and can only he 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.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Adams, Bruce C/Lynne A
802 Iroquois DR
Fort Branch IN 47648
7595
Bruce C/Lynne A Adams
802 Iroquois Dr State Parcel Number Legal Description
Fort Branch IN 47648-9729
26-19-18-101-000.001-026 011-00001-00 LITTLE YORK VILLAGE
l'r II t' I t t ta I t l u II nn P I t I It II t o II n n I III u I nI II I
39/40/48/49 PHASE 1
PART 2:TAXPAYER INFORMATION
Owner 1 First Middle Last
Q Au A 0H /Li-
"Address(number and street,city,state.and ZIP code) R'Same ms pas property address — - - -
S07- 1Ko9 vo/r Dr, ,-T cg, l'V 91 76 ��
Spouse First Middle Last
YNN£ Af(,50e AAAPi, s
t
Mailing Address(Number and street,city,state,and ZII'code) I�'Snt
ae as property address
02 g.� /S07 vo;f bY, 9vT 6rAv7 c/4u Ln� `-/7 6
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 elicible 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 hack taxes and substantial financial penalties. •
Owner I ature Date
RK HC 10 1979 io Dz illal 1I1 LL"t)1iCcCc
:esczibed, By State Ba;rd of Tax O�missioi�s
CLAIM FOR H(�"EESTEAD PROPERIY TAX CRQ)IT .FOR YEAR 19 �'� :
SEE BACK FOR PILIN6 INS7RUCTIONS ,
� I,�., �p �% /� � Osf� "' :�OdO / — o O
. __, .
/ IC/Ni/a^:z.--�� �_1JZ �^ Q -�i 2 r,' �. � v,� � ::� �t}' that on the lst day of
' M�rch, 19 , I, (v7e) occtmied as our prmc��a1 P1ace of resi.dence the follawing described real .
�roperty for which a F�rpste�d ?�roperty Tax �it is heseby.�;*+; claimed:
_. .
Z, (Y�) � wma3 ` :.. '..
❑ � �1'�4 urrier oontract . -: : � _::
: � have a .beneficial interest. in .the ta�ayer : ,�,,� / �,..-
Y Property Description in �,� ��� ��tl' l��'u-a'i-J ,_ Zb,anship
Taxing District iCity. Zbwnr 'Ibwnsh�P): ���2 `": : .-: -:1, . ..... _
��
Parcel Phmi�s .. � or legal description stxr.m on tax statarent:
' _ � :• . ... . _ - - - .
���� ���'�I�.�,a�.!"_; 39 -F 1G1�
:g.:_.. :_. • : , t: : - ` . ._ . ,: .✓/ :�; -.,.,:.;::!;;•- �i .�±.:
I* buyina om m�tract:.Owners nan�e (fee simole ckme�)
Cantract ra��orded in I�mrder's Office -. Recnrd No.'� , . Page
i If any portion of the residential structure or the land, nat e�eeding one (1) acre that
iinmecliately surro�s tl�at structure is used to pro�ice incane, descri.be the use and portion of
thz orooerty utilized to pxoduce ir�
� .
� P� other �unties in which u�dividual aans or is buying real pmperty - Coim �shio
,_ _ . _. . ;. - ;..
... _ _ :;: . .. �,
� - ,. .._ . ,... y;. 'r - CJ.-`'' T a .. . _ __': : _ viy �'I .
( � � - . . ' ' �.. .
� I hP- '�y certify `the above statere�it is true, oorrect a� co�lete -
'� . . .: � : . . .. � ._ . ..,: .. � � . . -...�,:..r:i " . . -� . .. � � �
. _ ,. .
,:
' . .. . , �. . . �. _ .. . ..
�:_ *Signature •_. .� • :n:::.: � ; : Street Address a7t � - = City. State azri .Zip Code
*Tn(ii�y3ua1 either owns or is buying imer a mntract that provides he is�to pay the
- P?�P�Y; taxes:on the.residence, or.has a beneficial interest.in_;the;tax�ayer. ,
_ ,.- FC1R ASSESSOR`S USE.ONLY : 1
. , _. �... . . .
; -.._.-:-.•_
. �
�. . . `..True Cash :';;:,� Assessed iicmestead
_ - Value Valuatian =.Valuation
Iani not exceeding 1(one) acre i�iately ,.- .>`
surxotu�dinq residential i�zvve�.nts . (1) � � . � � `' ; � � O , ' �`� O
Other Iand .: : - .::_ . . . . ' . . . . . _ . . _. (2 ) ' .:: , :.: �., _ . ��
Total iand (3) /����� ��.0 � i
Pesidential"Inpmv�nents - �llin4 (4) `
.� � t3'l� f�5
� : ,... ...._ :_ . . . � � � . .: :: a?..
Garaae ' ' (5) �
- motal c5) 3� A��- %�Zo�n ��1�77
other I�xwsnents . (7) " • . �
6 i� � .�.5 ca) ce> ' °Q.:: ; . :{:�:..7��_� �� �� /
i ,"�i I�rov�nts - I.ine ( ) p ( ) .
, .,,
Jcertify the alxwve is true.`oorrect� a� o��lete. `.= �=..-:::.': "'.:;.- :-: �+: r. -:-:.. :,
_ Y �/ - _ _ . _-.
l�� " Q f�1-rn� zlL� Dat.e . -
Signacure or A�aessor __ -
- � - ACTION BY AUDITOR - -. . . . _
_ ^_�_. '