Homestead_Adcock •IATL FORM.WCA I R_rw1 f tttASIALlt rokM ia-tA
MK/V ,10'STATE IXs, oats RI\TS.cwN PRf3WDW BY 11W DEPMty:NR OF L OCAL CUSTRNMTK FINANCE MtrI.I-r'at
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 eser for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 1344-7009 requires taxpayers who receive the homestead standard deduction to verify that they arc eligible to rceehe the
benefit and to provide additional identifym- information necesslry to allow county government to better monitor horttes:e-4d
filintts_This information will be kepi confidential and can only le 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.
PART 1: PROPERTY INFORMATION
Taxpayer Name Prnpertv Address
Adcock, Lonnie E/Mary R
•� .Box S9
llaubstadt IN 47639
10942
Lonnie E/Mary R Adcock
5037 E 1150 S State Parcel Number Leal Description
Haubstadt IN 47639-7915
1111111111111111111111111111111111 11111111111111111111111 26-23-12-400-000.003-024 004-00003-00 PT W SW 12-4-10 2 AC
D-10
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
x
Lonn1 .p F-m. c- 1 C_ C0r4-
•ng Address(number and street city,state,and ZIP code) - . — -—— -p Same as propertv nddresi .
503.1 E \ 15oS Aau \:3cAnA4 3t dtane, 41 (03<
Spouse First Middle Last
Mary (- case Adco ,
Mailing Address(Numbeiland street,city,state,and ZIP code) ICI Same as property address
5(21 5 2 F ISO 5 14au_ )SA-adk 1ti3eL+ oytr L4 '1 (o ,')°1
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 Signature p �//���� Date
•
�; CLAIM FOR HOMESTEAD PROPERTY TAX
= CREDIT/STANDARD DEDUCTION
� � Stale Form Sa73 (R6 / 403)
Prescnbed Oy Ne Department ol Local Govemment Finance
INSTRUCTIONS: See revcrsc side /o� /ilinq Insbur,(inns.
ad'o-"`P,};^ �ur• .•wrw..-. _ -- _
�u
FORM YEAR
HC10
..:.:�� . �•..,. :. .; "1;.;, 4.. . ._ . , .`•..._. . - -. .CER FICA710N STA MENT:� . � � -
" g "1'JLJ LJ �J
� h�Je) certify tha[ on the 15t ��� A�rcr, ��D�
I(4Ve) pi as our principal place o( residence lhe Ilowing described real property for which a Homestead Property Tac Credit is hereby daimed:
I(VJe) owned ❑ p,re buying under contr `-y� �!�
I� Have a benefidal interest in the entlty Nat is liable for the property taxes on the pwperry and that owns the property or is buying u�r �or�kct.
_. CaiBSON COUNTY AUDITOF
If huying om m�tracl. Fea Simple owner's name
RemrAefs oifice where contract is recorded
Recortl num6er � Paqe
s'E?% -�...c: _.' - . --"�._,-. -. r,�3>-.:�.- : PROPERTY OESCRIP O ?';.._ : :., . . - -- , .
County Taxnship � Tsing istrit� , owns �)
ar n et �( Le al descn tion
_ /� V 9 P /^1�/ O ihe PtoPertY ingy¢stian:
��
L � Real pwperty ❑ Mobile Homo (I.C. 6tf-7�
If any porlion o� Ihe residenUal sWCture w the land nol exceeding o�e (1) aue Ihat immetliatety surtounds Nai swcture is used to praduce income, describe Ihe use and portion
of Ihe D�operry utili2ed to produce inwme.
T f��/.'S'////G
County
I hereby certify the above statements are trve, correct and complele.
Address (number and slree(, dty, sfafe, ZIP code)
,\.
v,�r=� + -. v,s,t , � . - , 'E
y i_;js y?- s ASSESSOR USE ONLY _ � .� TRUE TAX
.:,zu5:«? :r.-.r. r... ,..`a.•- � _ - ' vnLUe
Land nol exceeding 7(one) aae immedialety
surrounding resiOenGat improvements. (� �
Other land (2) �
To[aI land (line 7 plus line 2) (3�
Dwelling (4)
Residentiel improvemenLS or Annually
Assessed Mobile I ManuFacNred Home Garage �5)
Other improvemenis �g)
Tctal improvements Qine 4 through line 6) (�)
TUaI value (line 3 plts line n (g)
I hereby certify the above is We, covect, and Signamre otAsseswr
complele.
Vrntying actbn - SignaWre ol Fwditor
20 _ Pay 20 _
Lesser of 1/2 Homestead
VauaUOn or 535.000
Counly
claimant
AT 1
i.'j:d?':i p".
Tavnship
J,
i�HOMESTEAD - NON-RESIDENTIAC;
_�-� VALUE - !;�::`VALUE-% � --
_ _- -_. -;..
�STANDARD.DE�IICTIONALLOWANCE"_�� � `
S
::4':. '�'!i -
. -3)c.+ ` _ - ' � -
.i_. �:i`i - _:
Date signed
Date signed
�'
i������� � � �.�3�i . - �