HomeMy WebLinkAboutHomestead_Adams (4)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fwm 5473 (R8 / {-03)
Prescribed Dy the DeOartment ot Lacal Govemment Finance
^INSTRUCTIONS: See revarse side !or liling ins�ructions.
FORM
HC10
YEAR
� M'e) ��Y.A?�X � ln.i��iu—\ A� A�Y1 ���� certi�Y � li s ay o(�Y ��
I(We upied as our principal place oi residence lhe following described real property for which a Homestead Pr T C dit is b ime :
I(We) owned ❑ Are buying under contract
, Have a benefidal interest in the entity that is liable for the pmperry taxes on the property and that owns the property o yi un nUact.
ti�1' � , �6��
If buying om m�traq. Fee Simple ownets narne
Remrders olfice where coniract is recorEed
''' ��', -^�'s': "t�33 -a;-�''`" `�'i:"•`t.4�.�_'�"`�: €
ts:.:,:n,�,�?'i�.e-...:s�rt n-,tiis3v �e
CounlY � _ 7armship
(`iN• town.
rarcei icer [I �7�
�np ��� � a��� � l Pb Is�tha Dro.
H any portion af the residenUal s4ucture w Ne land not ezceetling one (7 ) aae that immediatety sunounds that
of the property uWizetl tu produce inwme.
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I hereby certify the above statemenLs are� We, corted and wmpiete.
ZlP,mde)
Land nol exceeding 1(one) acre immediatey
surtounding residen6al improvements.
Other land
Tda! land (line 1 plus line 2)
Dwel�ing
Residential Improvemanfs or Mnuelly
A�es� A1obFb � Alma�red Hane Garege
Other improvements
TUaI improvements (line 4 through line 6)
Tdal value (line 3 plus line n
I hereby certify the above is We, corred, and
amplete.
Veritying action - SignaNre ofNiditor
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(3)
(4)
(5)
(6)
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SignaNre of Asseswr
co��iy
or claimanc
GIBSO�V CnUN?Y' �,�IDITOR
RecorO number Pa9e
question:
Real property ❑ Mobile Homo (I.C. 61.1-7�
ire is used W produce income, descri6e the use anE ponlon
Date signeE
sgned
SInIEivItNL!nill'/�-rv1 TItF15UAE0. W0.4IIIA
AIMn'EI�BYSi�ifIXHPDOF�A�vV�4�.9v P6TNPm0YTICUFPMiMLY�IKUMLC��:S6IiR:n.aCE1CH.l-_�J �
Gibson County Auditor
101NMain '�' � � � 1 '•�• � •
PRINCETON IN 47670 IndiriJuah aoJ rtu;riN mupks arc IimilN �o orc hnmeucaJ uandaN JNunitm. As ihe recttip� ol �his deduction Mrni¢s
mure beneficial. �herc is morc incrnmx th�n e�er (or humes�eaJ fiawi Ilom veaJ frduJ caasa hi_her Ia� 6ills fw all: thrrcfae.
� HEA 13�1-1-]0119 reqvim u�parers .vho rccci.c ihc Mrnes�eed sundard JNuction m veriry thnt th<y are cli=iNc �o rearne ihc
�����benefit anf ro p�w'idr ad�ii�io�ul identif'�in•, infwma-wn necr.�n� ro al-uw counh� grn'rmmenl ro bucr mmiror homesttaJ
filinfp. Ihis inlnrmatim will M AryV rnnfidential anA nn nnly h• amc_ ¢A hy autMrvavl tnum�� o�Teials. Thc Ikpann�� nf
I.ueal Gwcrmnent FivMC ��ill u.e this intumwtion w crca;c uwls thm will h:Ip cqmn� u(iiciab eliminarc Ipme>tcal traud.
OCT 2 2 �Utu
�`a� � �
�42f',IBSON COUNTY AUDITOR
Paul Adams
39 N 275 W
PRINCETON IN 47670-8517
�i�n��ui�����i�n����u��n�n�i�ini���ni�n��i����n�����
Taaparer Name
Adams, Paul/Susah
S[ate Parcel Number Lepal Description
26-11-10-200-001.775-027 006-01775-00 PT NE 10 2 71 1.0734 AC
X
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Owner I Firsl MidNe Las1
! � �vNr �/nS
ignUdi¢c�numneFaridstrenTciry.smec,and�ZlPcuJc)_'_ _—. _ _'__ '_r}''San��cmp�uyar}'WJ�e:;- ' ' --. .
L17
�J ' � fNG� dN � D
Socul Sceuriq� Number (lasi 5 dicin) Driver's Licenx/Sum IU Nmnbtt (Is.t 5 divib) Othcr (please sptcif in Part 4 below)
� `�
Spouu Firs[ Middlc Last
.SUS� n� �-iVN ���� S
Mailine Addres (Number and siree4 ��)', stale, and'LIP cexk) � Same bs pmpeny:wldresi
3� � a�� w �,�� �N �� ��� v
Socal Stturirv Numbcr (last 5 digia) Drivcrs Limnsc/Sta[c ID Niunbcr (la>� 5 digits) Uficr (plcasc spccify in Pan 4 bclow)
., . �
Each undersigned certifies, under penalry of perjuq•, that the above and foregoing infurtnation is we and correct and that he or she is elieible to
receive the homeslead standard deduction on lhis property. Each undersi¢ned al>o undemands th2t, by claiming additional homestead deductions
unlau�fully, he or she may be liable for back ta s end substantial financial penalties. �
Ownn S Uatc Tdephmc /
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