Homestead_Adams (4) SIM FORM!;v-,r sm tRW.W:[U FORM 11n
APPR(Vmarsr'Etrtvw)ne.MR*,TC'ran rtss,ram BY TIE DERARrMErr(w LOCAL GOERN•rt.'t r.aAsrEr.p.1-r-.t
Gibson County Auditor 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
FRINCET 476 mere bene. and married core incentive are a than to one homestead r andaN J:estead fraud ud the s higher r I this bills r becomes
q `, JIgNtL—,' ? G mere hrnencial,there is more incrnm<th:m ever for homestead fraud.Homestead fraud cause;hiSher tat bills(or all:therefore.
j,r HEA 1344-2009 requires ta.paycrs who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necessary to allw' county government to better monitor homesick]
filings.This informLmn will be kepi rnnlidential and can only he accessed by authnri/M rooms officials.The Depanment of
APR2 7 Lulu Loral 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
—
_ aV Adams, David L/Mary K
GIBSON COUNTY AUDITOR
600 E Locust
Fort Branch IN 47648
7733
David L/Mary K Adams
600 E Locust State Parcel Number Leal Description
Fort Branch IN 47648-1214
�n�rt�i„tltlltttltt IL lit tr�lttltlrttllt�ttill,ttll ��tI 26-19-18-303-000.245-026 011-00245-OO PT SW I&3-10.33 AG
PART 2:TAXPAYER INFORMATIQN
Owner I First Middle Last
Day L . A &Par,a3
410 ne Address(number and street,city-state,and ZIP code) — — __— -- - Same as property address— - - - — — - —
o0 E . C-acust St. Ft. 6ranc {5 , Ins. Li 76VS)
Spouse First Middle /� Last
mar)/ K. Adanet s
Mailing Address(Number and street,city,stale.and LIP code) E`Same as property address
6o0 Locust St. Ft- Branch l Irks' .
47 lc 42
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.
Own \Signature Date
/"�
�, �� 4 CLAIM FOR HOMESTEAD PROPERTY TAX
, ' - � CREDIT/STANDARD DEDUCTION
�.�� State Fortn 5473 (R2/5-92)
m • . .
INSTRUCTIONS: See reverse side 7orliling instructions.
STATEMENT
T y , F f ��
� �,� - ,
I� e ' i��
rA�� 91993
I fWe) _��/f/1/�_}_._y_/__//tK f{-(��// d cenify that on tfi'2M�(8�¢6t'March, 19_
�occupied as our principal place re idence the following described real'propeny for which a Homesiead Property Ta�c Credit is hereby daimed:
al (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 ihe property or is buying under a contraci.
- _ COMRACT RECORDED - . -
If buying on contract. Fee Simple owner's name . . _ _ . . �
Recorder's ottice where contract is recorded Record number Page
Parcel number
If any portion of lhe resitlential stmcwre or
of the property utilized ro protluce income.
Township
not exceetlinq ane
PROPERTY DESCRIPTION
'�5 —/U i o7 e1 RC'.
_. that immediatety wrwunds thai swcture is used to produce income, describe the use and portion
� � PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �
Counry Tawnship Counry Township
eby cenify ihe above statements are tme, correct and complete. Signac re of daimam ;
�- � I
ress (number and sbeet ciry, sfate. ZIP code) Q �
0 o r-_ �o�UST ��• lJRf)NCH� 1'�0 . g
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately
surrounding residential improvements. (�)
Otherland (p) �
Total land (line 7 plus line 2� (3) `I
Dwelling (4) �
Residential improvemenis .
Garage (5) �
Other improvements (6) .
Total improvements (line 4 through lina � (7)
Total value (line 3 p�s line � (g)
I hereby certify the above is tme, correct, and Sgna;ure of Asseswr Dace signetl
complete.
�ying action - Signature of Autliror , I Date signetl I
19_Payt9_
Lesser of 7l2 Homestead
Valuation or 52,000
S
ALLOWANCE
Signalure of -.or i � I Date signed