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Homestead_Adamson (7) STATE FORM 53569(RJB-10) TREASURER FORM TS-IA APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1.22.l I IMPORTANT NOTICE'TO HOMESTEAD.PROPERTY OWNERS 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 ever for homestead fraud. Homestead fraud � B auses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead s dard 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. . PARTI: PROPERTY INFO'MA ION Taxpayer Name Property Address Stale Parcel Number Leal Description: Larry J/Marilyn C Adamson 4103 w 1000 S 26-18-33-300-001-759-024 PT SW 33 3 11 6.79 AC FORT BRANCH IN 47648 0.2 Complete and return to: I®hIDD]DDHIIIMMUlI E11111C]©mM�® GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 Y PART 2:TAXPAYER INFORTIIATION - Owner I First Middle Last 1-0 cry i ne_ • a Disc ks Mailing Address(nu and street city,state and ZIP code) 1 Same as property address • ; • First Middle - - - - Last 111(�ri I r� �.e�ej� �c 1/0/0M5. o� Mailing Address umter and street dN.state and ZIP code) P Sare as properly address EH0 ?) La Ia-0 aS 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 = - - - — - r : : � . NOV 14 2U12. GIBSON LOu fY AU{JTnn .�.•�`•? s CLAIM FOR HOMESTEAD PROPERTY TAX dI x-. 4 '�;, , .—.-; : REDIT/STANDARD DEDUCTION � :� State Form 5473 (R2/1-90) ,' '•�• ` INSTRUCTIONS: See reverse side (or �iling instructions. CERTIFICATION STATEMENT FORM YEAR H�,o q / oD�%��o�v S_DD I(We) �� `-* ��' ��Mri.� � 1.��^'�6T certify that on the 1 st day of March , 19 �(7 �We) occupi as.our principal place of residence the following described real property for which a Homestead roperty Tax Credit is hereby claimed: �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 the �� property or is buying it under a contract. - CONTRACT RECORDED on contract. Fee Simple Owner's Name office where contract is recorded County aiy portion of the res re is used to produce QD��G �� PROPERTY D town, Number � Page s,P� .�c.J 3�� 3-ll �' 8S� c " or the land not exceeding one_(t ) acre that immediately surrounds that struc- the use and portion of the property utilized to p�oduce income. � / ./7 e 4 „ - ' - - / //l/� .. .� / � �i� —_-i -� _ OWNED BY CLAIMANT Ii�wiisiuN � �, certify the above statements are true. correct and- • Address ASSESSOR USE ONLV state and ZIP code) OTHER �- - �Ku TRUE TAX VALUE ' ASSESSED VALUE NOMESTEAD VALUE NON-RESIDENTIAL VALUE Land not exceeding 1(one) acre immediately � �. . , surrounding residential improvements (�) � Other land (2) Total land - line (1) plus line (2) (3) Residential improvements _ _ Dwe�ling _ (4) . Garage (5) Other improvements (6) Total improvemenis - line (4) through line (6) (7) Total value - line (3) plus line (7) (8) I hereby certify the above is true, Signature of Assesor Date Signed correct, and complete Verifying Action - Signature of Auditor Date Signed STANDARD DEDUCTION ALLOWANCE 7989 Pay 1990 1990 Pay 1991 1991 Pay 1992 19 — Pay 79 _ sser of 1/2 Homestead Lesser of 1/2 Homestead Lesser of 1/2 Homestead Lesser of t/2 Homesiead Valuation or $2,500 Valuation or $2.000 Valuation or $1,500 Valuation or $1,500 Signature of Auditqi� � , y/�1-� I Da� s� 3ed� l ' MMp • � i-R/11�,0