Homestead_Adkinsa^"`"�"° CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
�' ��� State Fortn 5473 (R2 / 692)
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INSTRUCTIONS: See reverse side 7or liling insWCtions.
FORM
HC10
YEAR
� CERTIFICATION STATEMENT
I(VJe) / �/� �� S• e that 7 d of March, 79_
I(We) occupied as our incipal place of residence the following descritied real property for which a st d pe redit is hereby claimed:
❑ I(We) owned ❑ Are buying under contract n QO�
❑ Have a beneficiai interest in the entiry that is liable for the property taxes on the property and that owns th�rQ�ey� i�vying under contraci.
J�,
CONTRACT RECORDED pF
If buying on wnvaa. Fee Simple owners name COVNj
,gSON
Recortlels office where conVad is recorded ' Record number Page �
PROPERTY DESCRIPTION
Counry Tovms ' Ta�dng disiria ( , town, tamship)
/� /Y'�7GA 7�"l�� � •
Parcel umber Lega descnpuon
� � �0 � ��
If any portion of Ne resitlen6al swcture or the land noi exceetling one (1) acre Ihat immediatey sunounds thai swaure is used ro protluce income, describe ihe use and portion oi
the property utilized to produce income.
' PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
SignaNr claimani
��by certify the above statements are true, wrrect and complete. f� - .
L
AO�ress (number and sneet, dry, sfa73 0 code) �
RR3 0 7
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (��
surrounding residential improvements.
Otherland (2)
Total iand (line i plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Oiher improvements (6)
Total improvements (line 4 through line 6) (7) I
Total value (line 3 plus line 7) (8)
I hereby certify ihe above is true, wvect, and Signamre of Assesor Da�e signea
complete.
Verifying action - Signature of Auditor Date signed
�t STANDAflD DEDUCTION ALLOWANCE
_ Pay 19 _
esser of 1/2 Homestead S
a n or 52,000
Sg�umre oi Auditar Date ' etl �
, —S = a
�
Gibs�r7'3aunty Auditor
101 N Main
PRINCETON IN 47670
1129
aur[ �oaai �,w�x: i r.��
.V IXfT'E11 BY cl�lf pMRDK YY��:\Tl.9n
iRlASL'lE0. f00.V SIA
InJi�'iJuals anJ �rttrriN coupb a�e limi�ed w a�c hnmateaJ .ta�Mard JeAunim. As the retttip� oi ihis dNuction bcconre.
morc 6emficiai, thcre ie mwe incenmx than e�er fur homr>xaJ &awl. Ilome�ead GeuJ causes hi�her uc bilis ti�r all: therefae.
HEA G-1-S-?O(19 rryuim iaipaeen w�ho recei.e the hancncad siandard dniuction �u arify du� �he�� are eliciMc �o rtrene ihc
benefi� anf io pnn'idc :¢klitional iJemfirim� infum�atiun necessary m alluw counn emrmmeni eo Ni¢r muniror homese:xl
filin�y.'Ihis in(nrnwion will he Atpl mnfdenlial mA rvn only M. arcr: ud M1y amhnrvnl rnmny n(Ticials.'I'ht Ihpanmem o(
Lucal Gm'crmneN FinaM'< will uae this infomwtion tu creaa ttwlt Ou� will h:Ip camn' ufficiaLs dfminnm hemmsieaJ (rauJ.
, • ' , , , .
Taanacer Name Prnnern� Addretis
Adkins, Roger E 3 as � w ry�ry ��ffS
xm�� Or
Roger E Adkins
-�-�-e�3e- 3�s� w m�,�y R�E,.�, D�.
PrincetonlN 47670-8472
�i�n��ui����n�in���u��n�u�n��ni�n�i�i�i���in�n��i�
State Parcel NumM1er
26-11-15-100-004.008-027
J
Princnon IN 47670
Leoal Description
M C ROBERTS TICHENOR RD PH II 11
D-17
,. ,
Owner 1 Firsl Middle Lasl
�� e� �. .�a�;�
c Ad rtss (number and itrett, city. smtc. end ZIP code) " -' - — ' - -' - -' - — -' 'amc'a4property odd+ev ' - - -- -' - - ' '
Social Security Number flast 5 diciu) Ihiver's Licaue/Sute ID Number (lui 5 digiB) O�hcr (plcau speciCy in Part 4 6elow)
,� � �
Spou;c First Middlc Laa
Mailing Addreis (Number anJ strttl cily, sWtc, und "LIP cale) �$ame � propeny add+esi
Soeial Stturiry Number (last 5 dibms) DmxYs Liccnsc/Stare ID Nwnbcr (la � 5 digils) Othcr (plcacc spccify in Pan 4 bclow)
sm¢
� . . �
Each undersigned certifies, under penalty o( perjuq•, that the abo��e and foregoing inform�tion is true and correct and that he or she is eli4ible to
receive the homestead standard deduction on this property. Each undersigned al;o undemands that, by claiming additional homestead deductions
unlawfully, he or she may be 1ia61e for back taxes and substaniial financial penalties.
O..�ner I� t�ue Ustc Tdcphone .
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Spoux Si re ��c Tekphonc -
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