Homestead_Adamson ,../.
STATE FOES'.lN Cl 1 yip, TREASURER FOAM TS IA
ArPRrw'ED BY STATE SIMRD Or M'rt R!,,,'E.!ix.v Ftr3NBFD BY n1r DEFARISn:MTCF LOCAL COVER:Mo FPLCE let.1.12:4,1
Gibson County Auditor 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standani deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than eser for homestead fraud.Homestead fraud causes higher tat bills for all:therefore.
. HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verity dill they arc eligible to receive the
benefit and to provide additional identifying information necessan'to allow county govemnwnt to better monitor homestead
filings. this information will he kept confidential and can only he accessed by authorized county official. The Depannwnt of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY LNFORMATION
Taxpayer Name Property Address
Adamson, Charles F/Helen M Trus
122 13ox frt A
Ilaubstadt IN 4 39
10771
Charles F/ Helen M Adamson Trust
10867 S 350E State Parcel Number Legal Description
Haubstadt IN 47639-7867
IIlulln tlt�lu ulirlI1u 1u t11u1n11u 1u tltllnl1nilltrT1 26-23-03-400-000.002-024 004-00002-00 PT E 3410 1.11 AC
D-9
-- PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
ha I" FAelefick 4d2CMsoa __ -- .
4111cg Address(number and street;city,state,and ZIP code) -Same as property address
/01' 7 Igo 6 #aaLs`talf / --hJ aha 97437
.,---
Spouse First Middle Last
hie eh Map ; e /112 Psi 5 % n
Mailing Address(Number and street,city,state,and ZIP code) (5aeTet property address
/ells- ) 3tC b 6- #a4`s7`z1-E , .fin 1 a h a y7t3f
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 Date
.•
� FOpM HC 10 7979 � To & FiIM in DuD���ate
Preuri0e0 By SWte BoarE of Taz Commissioners �
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19z,L
SEE BACK FOR FILING INSTRUCTIONS O�N-�QQiI�r�Da
����-� `'�" �,1�-�'�.� certify that on the 1st day of
,.�a� , 19�� I, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is he�eby being claimed:
I, (We) C23�owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description
Taxing District (Csit}r-Tewrr, Township):
c�� o13 -o�-%��-�6�3s Qoa -aa �
Township .
Parcel Number I I -. I , I I� I or legal. description shown on tax statement: __
%�' �' � 3 - 4�—� o /• / / Cc.cicGO�
If buying Ofl contract: Owners name (�� �'mple owner�
Contract recorded in Recorders Office - Record No. Paqe
If any portion of the residential structure or the land, 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:
certify the above statement is true, correct and complete.
,P,P. z
$lreet AOtlress
County
Township
Ciry. State enE Zip CoEe
�
% r-�
, � ��3s
Fi�/,s/%S
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' 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 -
True Cash Assessed Homestead
Value Valuation ' Valuation
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land �y T T �;1 �
Total Land �V- e �
1 y�� ��
Residential Improvements Dwellin9
JUN 1 � 1979
Ga� e
Total
Other Improvem�� AUDITOR '
//
T��-� 1moLovements - Line (6) plus (7) equals (8)
--��i ertify/tha� above is true. correct, and complete
Signa.ure o' A=_sessor —� �
(�) SG O
(2) � O
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c4) i� a�o
(s) —
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- ACTION BY AUDITOR -
/70 /70
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