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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sta[e Fortn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side for liling instructions.
FORM
HC10
YEAR
CERTIFICATION STATEMENT
I(VJe) .� O � 11 �� S, ce at n t 1 o M 9_
I(We) occupied as our principal.place of residence the tollovring descnbed real property for which a Homestea ope ax Credit is hereby claimed:
❑ I(We) owned ❑ Are buying under contract � O CT 1 O ZOOO
❑ Have a beneficial interest in the entity that is liable for the property tazes on the property and that owns the pro erty or is buying der a c tra
CONTRACT RECORDED pUDITOR
If buyinq on contract, Fee Simple ownels name
Fecorders otfice where contraci is recortletl � Recortl number Page
PROPERTY DESCRIPTION
Counry Tovrtuhip Ta�dng district (c" o�m, fownship) /
/f� So � /fi�K�4- �in/c-C�'n�i
Parcei mber LegaldescripGon
0/�- O16�'7-00
If any ponion of the residential strucWre or Ihe lantl not exceeding one (7 ) acre that immediatey surrounCS thai structure is usetl ro protluce income, descnbe ihe use and portion ot
the property uGlized ro D���e incnme.
PROPERTY OWNED BV CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
Signature of claimant
ereby certity the above statements are true, correct and complete.
Address (number ana sfreef, ciry, stale, ZIP pode) '
7 a s � s. Gr�?so�u r'2,NC.c fo,u S,v y7 7
ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding 7(oneJ acre immediately (��
surtounding residential improvements.
Other land (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvemenis (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify Ihe above is true, correct, and Signamre of Assesor Dare signetl
complete.
Verifying acGon - Si9nature ol Auditor Date signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 79 _
sser of 1/2 Homestead 5
tion or 52,000 �
Signamre of Autlitor i Date signed
!� —/(7 — ed
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
1133
nrvarnen
iRFASUtfA IORV :Sin
'iiQ:A CEIC61-IZl.1
InJividual> and ma:riN couplo are limited �o oce home�tead 9andtN JeJunion. 3s �he �eceip� ol'this deduciion beconre±
more beneficial, thrre is morc immtne than ner for homnrcad BauJ. Ilomo�ead frand cau�s hi�her �a� bills (or all: therefaz.
H!A 13i�3009 requim uxparen who rereire the hom<smeJ smnda�d dnluction m.erily that ehey ae elieide w mcei.e tAe
benefit aN to p�m�ide adUitional idemfirfn_ fnformavon riem'vey to allw� vounry ¢m�emmrnt tu bener mmiror Mmmcid
filit�,c 71tis in(amulim w�ill 6r AqV emGvential and can only Fe ateecavl hr autMr'ved coumy ofi'eia6.'ITr Uepanmmi of
I.ocal Gmrrtmem FimMC will ua thi5 intormmion �u create 4vls tlut will heln ramre ofiwtial. dimiwm h�enesteaA &auA
Cris A/Karen Cohoon
725 S Gibson
PrincetonlN 47670-2607
�i�u��in�i��n�n����nni�i����n��ni�ni�n�i�i���u�n��
Taxpaver Name Prnoern• Address
Cohoon, Cris A / Karen
7? 5 S G ibson
Princcion 1\ ;7670
State Parcel Number Leeal Descriotion
26-12-07-403-001.687-028�019-01687-00 SMITH ADD 4PT
Y
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
�r;
;o-m, cirv, sw�c, and ZIP cadc)
nbcr (last 5 diciLt)
Ka�-e� � Nac��N�
Addrtss (Number and sYree4 �q', slale, nnd "LIP code)
suriry� Number (las� 5 digirs) Drivds LicensdState ID N (la;t 5 digits)
_ _
O�her (pleasc specify in Part 4 below)
ca�.od �
��une :u prapeny ndd�ec;
O[hcr (pictic 5{xciF in Pan 3 bclow')
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undersicned certifies, under penxlry of �rjury, that the above and furegoing infonnation is true and correct and that he or she is eligible to
:e the homes�ead standard deduclion on this property. Each undersicned also understands that, by claiming additional homestead deductions
rfully, he or she may be liable�r back taxes and substantial financial penalties.
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