Homestead_Adams (3) SINCE FORM!RYA rE+P'1 lRrAStREA FOAMi-IA
.APrWNED BY CECIL MHRD Of ACCO NTA 2N.0 PIZJSNBED BY mr DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC 4-Et-r-.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and harried 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 1344-2000 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to tecene the
benefit and to provide additional identifyine information necessary to allow county government to better monitor homestead
flings.This information will he 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 cotmty officials eliminate homestead fraud.
c
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Adams, Charles K/Betty Jane
105 S Lincoln
Fon Branch IN 47648
137
Charles K/Betty Jane Adams
500 N Hillcrest State Parcel Number Legal Description
Fort Branch IN 47648-9785
ltlttlltttIrIltrtItt lIrr lrlFltrlttt lIt tlt tltItIltttll I II 26-19-18-302-000.002-026 011-00002-00 HILLCREST 50
x
PART 2: TAXPAYER INFORMATION
Owner I First Middle 4 Last
C$4.0121_12-1C Qeit/ r gt-pijan+-1...ria C �� _ 14vn,S
-- g Address(numbs end street;city;szre•and ZIP code) — - - -- — -- — ly[f =EC ms propeny add s —'- --
0 N /.�sLLC 'U Sri- f�
Spouse First Middle Last
Mailing Address(Number and street,thy,state,and ZIP code) Same as properly address
511.9 PJR ► ZLC Jeff-Cr
+
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 I Signature nn Date
FOFlM HL 70 1979
Preuribe0 By State BoarE ot Tax Commissioners
CLAIM FOR HOMESTEAU PROPERTY TAX CREDIT FOR YEAR 19 �� y
To Be FileE in UuO���ate
SEE BACK FOR FILING INSTRUCTIONS
//, n/l/ O//-DODO�-O�
��P:e)�rn�, �-�+- • K• 'f �-�- � certify that on the 1st day of
�iarch, 191�, I, (We) occupied as our principal a e of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) �owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in � County �-�" Township �
Taxing District .�.C.iLy, Town, Towast�ip): ���t.f �/�-r1�-�
Parcel Number or legal description shown on tax statement:
%��" .� o
If buying on contract: Owners name �'� S1np1e °""e0
Contract recorded in Recorders Office - Record No. Page
If any portion of the residential structure or the Iand, not exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property:
� hereby certify the above statement is true, correct and complete.
� . -
SOON�
POaress
County Township
. ,6,�.a,r,.�.2,, �,... � �!� � S
clry. Sta�e ano zio �e .
Individual either owns or is buying under a contract that provides he is to pay the property taxes -
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1�e) acre i�mediately
surroundin9 residenlial pro�eme `�1s � �
Other Land !��
Total Land .�� ,
Jv 2.`; i91'9_
Residential Improvements Dwelling
� � ��%�L„ .'�f"Garage
-�r1iCBiU
AU��,�� Total
Other Improvements
T^'-'-Improvements - Line (6) plus (7) equals (8)
i��y certify the above is true. correct. and complete.
• . .-. _ .
SgbWre oi Asseswr
Approved:
(�)
(2)
True Cash Assessed Homestead
Value Valuation Valuation
/SSo ��o �.30
(3) / $ 80
(4) 7``!'�'a
(s) __a�-{�B-p
�s� �
(�) —i��
(8) /�! 77.�
a.11o0
- ACTION BY AUDITOR -
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Date: — _(.4�f �2�