Homestead_CookCLAIM FOR HOMESTEAD PROPERTY TAX
CREDR/STANDARD DEDUCTION
stata Forrri u73 (Re � 403>
Reambed by ttro DeGgNnml d Local GovemmeM Finatxe
INSTRUCTIONS: See rEywao afda br fIDnp its6uc8iy�c
FORM YEAR
�J� ��/.�J1 � � � H��
1/ �,
SEP 2 0 2006
, M,e� � ,.,, ��, .�,.-�
certity thal on the 1 st day of March, 20_
v tt 1Tl�R
I(VJe) occupied as our principal lace of residence the following descnbed real property for which a HortLes[eBd�P.ropeity�'�a< C�led'�i is�hereby daimed:
�I(VJe) owned ❑!ve buying under contract
� Have a benefidal interest in the entity that is liable for the property taxes on Ihe property and that owns ihe property or is buying under a conVact.
If buy'ug on conVact, Fee Simple owners name
RecorEefs olfice where conVaq is recorded
County � Tamship
Parcel number description
—63
N any poAion o/ ihe residential strucW re w the land nd exceetling one (1) aae ihat mi
of Ue prop util�ce inmme.
a�-�a-���o3-�.0�0 oa�
A
Record number � Page
Ta�ing di Ifi l, 't � town, townshiP)
Is ihe property in question:
❑ Real woaertv ❑ Mobi�e Mon,o u.a s,.,-n
iatey wrrounds that st`ucture is used b produce incwne, describe the use antl partion
���z ���� �'-��� � � TRUETAXr�vk �ASSESSEDVALUE ,�HOMESTEAD�'� '�yy` „�'E N ftESIDENTIA� fr ��
'�� � ASSESSOR'USEONLY- �II.c�'{y < ' ypLUE�t'"�'ATt700°/a'OF�TTV VALUEr' y '• ik '-+'
a�'+.a.� .�:?"� x_a1�1*�S?"�'F'ir°S.�i'.:�r�.e�.�.. �. _ � dfi��� ;�
�.��c. � .....»a a"v"-.i�'{:^....,.,.... st,¢'-_VALUE �� �
Land not exceeding 1(one) aae immediately "° rR y'Fa ��'�-�'�fb'� �tu HM
� 'sr �: � f��z�3!qc3
surrounding residential improvements. (� � ti'� �;v+ �`� ���!, �,� 4�
Otherland 2 t a _�'+.� �•
( ) ����f'',�t ���
Tolal land (line 1 plus line 2) (g)
.. t �r=n. ,.i,�- ...
Dwelling (4) �� �r-��`r����� . ��� �
Residentiel improvemenLa or MnuaOy -��, °�'�� '�' �
Asaesaed MobOe / ManuFacNred Hame
Garage (5) L�,a,z g� �`f _�,�.�,'
� --_�Ya�•�--�;;��'
<,»t,-[ '�.�'=.:��':
Otherimpravements (6) �.�"��' � "=
.:z°.:?�``t?�'�
Total improvements (line 4 through line 6) � (��
Tdal value (line 3 plus line n �g)
I hereby certify the above is We, corred, and Signawre o(nssessor oate signed
complete.
Verilying action - SignaWre of /Wtlitnr Date signed
-�F+'.�^��''"L"L�'`�r z-_��.i ���r��:�'U�,1�:; ��1DARU;OEDUCTIONAL'COWANCE.:x�'�+��, fyx'it,��'� �=F� 3���{:f:..��,.x'ea-m
20_Pay20_
Lesser of 1/2 HomeStead $
wuatan a 535.000
Sgnamra of Auditw � Date signed
•
Gibsan County Auditor
101 N Main
PRINCETON IN 47670
0
2536
SIAIE f fMM! � W �R`I sw�
1�.F5(N�mBV
1RElNlGR f00.M 11.�
InJividuab anJ marriN coupla am limited �o onc home�eaJ �andaN Jerluninn. Ai �he receipt oi this dedunion bcronres
murc beneficial, ihrre is more inernti�e than e�er (or homes�zazl &aud. Ilome��eaJ frawl causes higher taa bills for all; therefore.
HHA 1331-3009 requires mxpa.<rs .cho receire thc hanesteaJ sandaW JNuction in rcri(y �hat tM1ey arc eliciMe m mmi.. ihe
benefii an1 io p�m'ide a�klitio�ul idrntiiyinn information riecc>'vey tu allw� eounry �n'rrnmrn� �o bener moniror homrttead
fili�,�. This infamuiion will hr Aery eonfidentinl mA c�n onl�� M� aece.aN by awMnznl rouniy nlTicials. TM1e Ikpanmrnt o(
Lucal Gmemmem Finamn �rill ux ihis iniormmion W vreate 4nls Ihat will h:!p �rount7� otTxiaL. diminve hannmml fiaud.
� � � � � �
Tnapa��er Name Pruoem• Address
Cook, Christopher A
Christopher A Cook
401 W Emerson St
PRINCETON IN 47670-1326
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'ynu�rv(r�;mb:.�rund3vec;�ciry':�s.;.:.:a:�dZl!':odci' —
'vl l�t�, ��'Ic25v� .S'�
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Addrtss (Number and slreei, cil)', smle, and ZIP cale)
Numbcr (lazt 5 digits)
301 \V I:merson
Prinretnn IN;7670
State Parcel Number Leaal Description
J( 26-12-07-103-003.080-028 019-03080-00 BROWNLEE ENLG 3 PT
I Lv0/�
__ _ _ _ _ _ f�_c=rtrcaspmTMrtynddfic—_
Pr�,�Pw� , L� v����
nnber (I�i 5 digib) Other (plcsse sp¢ify in Pan 4��aw)
� Same u pmprny aJdrt�
(Picasc �eciN in Pan 4 bclox)
Each undersi�med certifies, under penalty of pepury�, that the above and foregoing informa[ion is true and cortect and that he or she is elieible to
receive the homeslead standard deduction on this property. Each undersi¢ned also understands that, by claiming additional homestead deductions
unlawfully, he or she may be liable for back taxes and substnntial financial penal[ies.
Owncrl Signpnuc Ua4^ Telephonc �
/�_ .���� S�s�i� �
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