Homestead_Adler (6) •1 • STATE rORM!Mt.tFC IY.rv. TREASURER RAW,3-IA
.APPROVED BY siAtL BOlRonrfrCrOUNTC,Y/ry PAr3Rlaro BY 111E DFPARTNEYTUr LIXAL GOvar,Nsgra FINANCE ICo-i.Ie-,.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individual.and married couples are limited to one homestead sandani deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than e'er for homestead fraud Homestead fraud causes higher tax bills for all:therefore.
HEA 1344--2119 requires taxpayers who receihe the homestead standard deduction to verify that they are eligible to receie the
benefit and to provide additional identifying information necessary to allow county gmemrnent to better monitor homestead
filings.This information will IM Leo confidential and can only be accessed by authorized county officials.The Depannrem of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Adler, Mark A/ Beverly A
Rr I Box 96-z
Haubstadt IN 47639.
9479
Mark A/Beverly A Adler
11039 S Owensville Rd State Parcel Number Legal Description
Haubstadt IN 47639-8641
_ 26-22-.10-100-001.756-024_ 004-01756-00 FIT-NW-10 4-).1.6.83 AC— - -—
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PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
�IRRK
44A/1) n&C//2
tg Address(number and street.city,state,and ZIP code) me as propeM address
//0 3 9 5. Owc-Ais iLce /COMO, #/9U6ST DT I �iJ V 76039
Spouse Middle Last
,Q&deR y INN/ Ate,e.
Mailing Address(Number and street.city,stale,and ZIP code) me es
as property address
//0 . _ _d02Eas0c61-E ARO /�Au s-rRIJT u1�_ .5(76._39 - --
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 Sign: • Date
E� "��°, CLAIM FOR HOMESTEAD PROPERTY TAX
s��� CREDIT/STANDARD DEDUCTION
.�.�; � State Form Sa73 (R2 / 5-92)
�au
INSTRUCTIONS: See reverse side !or filing instructions.
FORM YEAR
HC70
���� �
on ihe t$t d�yof
� occupied as our principal place 8f residence the following desctf�d real property for which a Homesie mperty-7aa�C�edit's Fj��lty-cl��med
V _tiv� ✓�"„'-v q!)UI70R 1
V I (We) owned ❑ Are buying under coniract - - -� - • • ^f;;' �. �
❑ Have a beneticial interest in the entity ihat is liable for the propeny taxes on the property and that owns ihe propeAy or is buying under a contract.
� - � CONTRACTRECORDED� -� � . . � �"
It buying on contraci,lFee Simple ownefs name . _�, �
Recortler's oNice where contraM is recortled Recortl number Page
. a .
� " - ' PROPERTY DESCRIPTION �
Counry. � Township � . -Taning district (ciry, rown, 7ownsAip) •
P � I er i � _ Legaldescription � �� /D � ` ('j r�
'' ! �j.
If any ponion ot the residential stmcwre or the land not exceeding one (�) aae that immediately surmunds Ihat structure is used to produce income, tlescribe Ne use and portion
of the properry utilized to produce income.
�l�l —///� /////�
PROFERTV OWNED BY CLAIMANT IN OTHER COUNTIES
Township Counry
cx.��rn.o 01 ���im�m _ ' "
��Uj' I4CI111�' IIIC QUUVC JIElCI1lClll� tlIC IIUC� 1.V11Cl.1 QIIV WIIIFlICIC.
Address (numbe� and street. ciry. sfate, ZIP crotle)
�/ /2/�/
" ASSESSOR USE ONLY
Land noi exceeding 1(one) acre immediately
surrounding residential improvements.
Otherland
Total land (line 7 plus line 2�
Dwelling
Residential improvements
Garage
Other improvemenis
Total improvements (line 4 through line �
Total value (line 3 p�s line �
I hereby certify ihe above is true, correct, and
complete.
79_Pay 79_
Lesser of 7/2 Homestead
Valuation or 52,000
(�)
(2)
(3)
(4)
(5)
(6)
1�)
(B)
TRUE TAX
VALUE
otASSessor
�
i(o � �✓Q��
ASSESSED HOMESTEAD
VALUE VALUE
DEDUCTION
S
NON•RESIDENTIAL
VALUE
Date signed
signetl