Homestead_Adamson STATE FORM 53569(R318-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.I 22-8.1
.0 e. - IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS. M
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
7 d
causes 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.
yt :. . , .- PART1: PROPERTY'INFORMATION 1 ■ x• r ' , >e ,
Ts tamer Name Property Address State Parcel Number Leal Description:
Ronald R Adamson 309 E PARK ST 26-19-18-301-000.236-026 PT N SW 18-3-10.32 AC
FORT BRANCH IN 47648 HILLCREST 9 PT
Complete and return to: gnnsDnn.en Bn cone.. ev:nmm^sn-r
IunuGnuuCul�iCGCuu6�Cum�Il3iuuuulluluu.11CCu
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
'r^, - PART 2: TAXPAYER INFORMATION ,.w• . W. 'si6''C.`
Owner First Middle �(r r�// / Last
�>/(/A / A7 /l 14,0 50 °�
Mailing Address(number and street city,state and ZIP aide) / [)same as property address
spbu5e First Middle Last
Tudy An�� Acia_ , sv2
Mailing Address umber and street,city,state and ZIP code)
�/��, /I Same as property 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.
Owner 1 Signature Date
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R2 / 5-92)
FORM m
HC10
YEAR
IIVJII'lUIiIIVIVJ. JCC ICVCIJC>IUC IV/ llll/Ilf 1/Ii1I114tIVIlJ. �- / f_��
J
��';J CERTIFICATION STATEMENT
e) / �� U�/ certity that on the 1 st day of March, 19_
I(We) occupied as our principal place of esidence the following described real property for which a Homestead Property Tau Credit is hereby claimed:
❑ I(VJe) owned ❑ Are buying under contract �
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and thai owns the property or is buying under a contraci.
- CONTRACTRECORDED �
If buying on con[racL Fee Simple ownefs name
Recortlers oRce where contract is recorded � Record number Page
� PROPERTY DESCRIPTION
Counry . � Township Taxing distnct /ci wn, t shiD) .
/f3S a.J cC,c/, 0.✓ , C,�{,
Parcel number Legal descripGon
� - OC72��p-00
If arry portion af the resiUential structure or Ihe land rwt exceeCing one (7) acre that immed�atey surtounds ihat swcture is used to protluce income, tlescribe the use afM ponion of
. the pmperry utilizetl ro pratluce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township - Counry TOVmship
Signat daimant
��reby certify the above statements are true, correct and complete. �
Address (numberanC street, ciry, state, ZIP codeJ '
30 � � sl. r � ..
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding t(one) acre immediately (��
surrounding resideniial improvements.
O[herland (2) . �
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements -
Garage (5) �
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, wrrect, and Signature of Assesor Date signed
complete.
Veritying action - Signature of Auditor Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Les r Homestead �
al ation or 52,000
Signature of Auditw Dare signed