Homestead_Adamson (6) tIME I ORM!KY.IR/fwd trE'SLYR FORM:SEA
YEP ROVED BY'TOE.',flan)or-NCr4VR.BEN EMBED BY THE DEPARMENE OF LOCAL CAVERYmrer FEASCE ICVIY2YL.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 standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than eeer for homestead fraud Ilom stead fraud causes higher tat bills for all:therefore.
•
HEA 1344-2009 requires taxpayers who receive the hanestead standard deduction to verify that they are eligible to receive a the
benefit and to provide additional identifying infomtarwn necessary to allow county government ro better monitor homestead
filings.This information will be Lept confidential and can only be accessed by authorized couny officials.The Department of
Local Government Finance will use this information to create ads that will help count:officials eliminate homestead fraud.
- _ _ . --a. — - •• P•.'T-t?PROPERTY INFORMATION__ ___
Taxpayer Name Property Address
Adamson, Jeffrey C/Carrie R /o6Gf 5' 5Cc r
Ilaubstadt IN 4763 L"
3403
Jeffrey C Adamson
10661 S 350E State Parcel Number Legal Description
HAUBSTADT IN 47639-7871
1,1. il..,IFII,,,.IIEIFI,,I,,,II,,�.l...1. .11.11 11111111 26-23-03-400-001.412-024 004-01412-00 PT E 3-4-10 1.96 AC.
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
CEYl_RF /[h r4mS DA/
STg Address(number and s .city,state,and ZIP code) Same as property address
Lac(9/ S 3 SD /4S1:nd , _Sir%_. 4(_-7.4i 72 - -
Spouse First Middle Last
ea.r'r it C. ("?.. . /ID/q,,4-1so/✓
Mailing Address(Number and street,city,stale,and ZIP code) 13-S*AR 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.
Own _ 'e Date '
-
I`
CLAIAA FOR HOMESTEAD PROPERTY TAX ��C FORM YEAR
CREDIT/STANDARD DEDUCTION c�o
Stete Fortn 5/73 (R6l t-03) ' � ��-4
PreaaibeA tY the DeDB�4mnt d Locel Gm�xronent Finance � Ji�J
� INSTRUC710NS: See ierena tlda Ib �Shp bMiycSpna � �
_.��'-�,�.?'i�',€�a�'�'r�s:_"r,_.���'t..'�'.i�'.�,t"� �a ��CERTIFICATION�STA7EMENTx`'y `i+,.u��=t`p�a,'F �:.�-` � : _zr-- �X_"�-'-`' �` z .-...�.
�r� _ 3-5-t .a.: %
��e) � � wvv �`'�-� cer6fy that on�tl4e,�1s`dayyoi,March, 20
v —
I(We) occupi s ncipa ace of residence lhe following described real property (or which a Homestead Property Tac�Credit is hereby daimed:
❑ I(VJe) owned ❑ Are buying under contract GIBSON COUNTY AUDITGR
i'Have a benefidal interest in ihe entiry that is liable for the property taxes on Ne property and that owns the property or is buying under a wntraU.
If buying on conVad, Fee Simple ownefs name
coniracl is recorded
County
P�I V�' �
Tamship
Ta�ing tlistricl (dry, town. (ownshiP)
Is Na property in queslion:
❑ Real prop�
Record numDer
❑ Moblle
Page
�N' �y� portion ot Ne resiGenUal sWC4ire w Ma Wnd not exceeding one (1) aae �hat immediatety wnounds I�at swGUre is use0 b produce income, describe Na use antl ponion
ProPeM uUlized to protluce inmme.
`I��P#c�G a3 -o3-�-cn/ �ia-oa�
20_Pay20_
Lesser of 1�2 Homestead
wuawn a f35.000
Sgnature ot Auditor
b^-O6