Homestead_Adams (5)s��"�
E i CLAIM FOR HOMESTEAD PROPERTY TAX
r CREDIT/STANDARD DEDUCTION
•�;� State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side tor /iling instructions.
FORM ' YEAR
HC10
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I(We) � VV)_�l�yV�— certi that on ihe 151 da of March, 79_
�+) occupie s our principal place of residence the following described real property for which a Homesi�Pmperty T Cr t is her y cl " ed:
L� I(We) owned 0 Are buying under contract �� ��� ._�' �„_
�' . ._. . ..�.,•. !„ .,��iTOR
❑ Have a beneficial interesi in the entiry that is liable for ihe property taxes on [he pmperty and that owns the property or is buying under a contract.
� � CONTRACT RECORDED � '
If brying on comraci, fee Simple owner's name �
Rewrder's office where contract is recorded Record number Page
' � PROPERTY DESCRIPTION "
Counry � Township - Tax=ng disirict (ciry, lowq rownship)
Pyrcel n�be- �a i 8 6-� � Legal tlescription �� �� a a- a� I' ��' ��
�
T
CJ lJ
If any ponion of the residential strucmre or the land not eeceeding one (7) aae that immedia[ety surwunds ihat siructure is used to produce income, describe the use antl ponion
of Ihe properry utilizetl to produce income.
PHOPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
Counry Township Caunry Township
.�by certify ihe above siatements are irue, correci and complete. Signawre clai am
Adtlress (number and sbeeC ury, sfate. Z/PCOde)
ASSESSOR USE ONLY TRUE TAX ASSESSED NOMESTEAD NON-RESIDENTIAL'
� VALUE VALUE. VALUE VALUE
Land not exceeding 7(one) acre immediate�y
surrounding residential improvements. (�) -
Otherland (p)
Total land (line 1 plus line Z� (3�
Dwellin9 (4)
Residential improvements _ �
Garage (g) �
Other improvements (6)
Total improvements (line 4 through line � (7) I
Total value (line 3 p�s line � � (g)
I hereby certify the above is true, wrreci, and Signamre ot Assessor Dare signea
complete.
Verityi�g action - Signa:ure ot Autlitor Date signetl
'��
19_Pay19_
Lesser of 1/2 Homestead
Valuation or 52.000
of Auditor
STANDARD DEDUCTION ALLOWANCE
S
Gioson County Auditor
101 N Main
PRINCETON IN 47670
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584
��AR fO0.M �)'MIP0./ s�Yl ipF.15U�,lA Po0.V �11A
n��Mw'EDBV<l�iCMMPOTNY4Ta.br� PAGANdm�Yi11CUF1M�OFLOGtC{NeR.VMQ."IN: \CEM�I.IS:J.1
' � ' • � � � 1 . . � . . � .
Individuals and invtinl muple� arc limiled �o ore home9csd aandaN dNunion. As �he retcip� of �his JNuaion 6ecomes
more beneficiai. thcre is morc incentnx than rc<r for M1omesteaJ fraud Ilomorra�l fraud causa higher ta� bills for all: Ihertfore.
HEA 13Ai-2009 rcquiles uapa�en vho recei.e ihe hanestead standard dNuMion m serifv that they are elieiNe �o mcei�e Ihe
b[Ilffil ]n11 t0 PN�'id[ .1dt11�iONl idfnli��'1(IC IfltOrtll]t�0� IICCC�S.In' (O dIIW' CW11t�' ¢P'tfi11M11 ID btitt! mMItW MrtCStt�(1
filim�. Ihis infarmmion will br A� eonfiucntial and can nnlp l+e acressed M1y awho(vN comry nff¢iais. The IX�wnmm�i o(
Local Gov<mm<N Pi`um�e will mc Ihis intorma�ion W areatc twls tlwt o�ill h:Ip cnm�n� offxial.. elimina�c Fam<stead freud.
John K Adams
1941 S 250 W
PrincetonlN 47670-8166
I�I�,II���I�II��I���III���I��I����II�II���II���I��I���IIII���I
Tasoaver Name Pmprm• Address
Adams, John K
19Ji S?i0 w
1'rinceton I\ i7670
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State Parcel Number Lepal Descripiion
26-11-22-200-002.186-027 oos-o278s-00 PT SE NE 22-2-112.57 AC
D-17
This form MUST be retumed to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
1 Firstl
�� ti �
g.Address (number m'd'>voct, ciry, sste, and ZIP code)
/ 9 y S zso W,
$murity Numbe� (last 5 digiu) Uriver's Licrnx/Sta�
Addre55 (Number and 4rce4 eiq'. slaie, anJ "LIP cak)
Stturiry Numbcr (lact 5 digi�s)
5
5
/9�i9,", S
as pmperty add`�
Othcr (plcsse specify in Part 4 bcbw)
� Same u pmpmy addres;
Other (plcasc spccify in Patt 4 below)
indersigned certifies, under penalry of pzrjury, that the above and foregoing infortnation is We and correct and that he or she is eligible to
e the homestead standard deduction on this property. Each undersianed al>o understands that, by claiming additional homestead deductions
fully, he or she may be liable for back taxes and substantial financial penalties.
1 Siymamrc Datc 7'elephonc
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