Homestead_Cook (3)Gibson County Auditor
101 N Main
PRINCETON IN 47670
3222
iliiElORN �!KIk i fN`I
PElYR16m �Y illf
iPFASURER fORN SIA
IiWiciJuals anJ rturriN coupks are limi�ed �o orc home�ead uandaN U:duaion. As the receip� oi �hi> dcxluction 6ecomee
mure beneficial, therc is morc fncencne than e�er ior homesmad fraud IlomesrraJ frzud causes hi�her taa bflli fur all; rherefae.
HEA 13J-1-]IXW requim uapapers .cho rscive thc hanesecaJ s�andard deAuoiun to reri�y �ha� thev are eli�iMe �o mcei�c �hc
benzfit arxl ro p�m�idr :�dditional idemii�ing infurmarun necessarv to allw' county gmrmmem to b:[Rr monf�or honx5re:x1
Filin�. fUis inl'nmuiinn w�ill M kryw eontidential and can nnl� M. aecec�ed M1c aWhorized roumy n0icials. The Ikpanmem of
Lual Govcmmem Firt�nce ��ill u.e thfs iniormauon [o n<atc [wls �ha� �rill help oounrv WTidals climinmc Iwmn�eaA RauJ.
Jeffrey L/ Donna L Cook
102 Freddie Ann Dr
PrincetonlN 47670-3112
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Taxnaver Name
Cook, Jeffrey L/ Donna L
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Address (Number and svee4 ciry�, state, anJ ZIP cuJe)
Securin� Numbcr (last 5 diei�s)
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State Parcel IvumAer
26-12-08-104-001.767-028
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Prnpertc Address
10? Fnddic Mn Dr
Princeton IN 47670
Leeal Descriotion
019-01767-00 EAST HILL 9
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spr�pert�eddmss "'—
O�her (plcue specify in Pan 4 below)
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�Same u p�opem address
Othcr (plcasc spcciH in Pan � below)
undersiened czrtifies, under penalty of perjury, [hat the above and foregoing information is true and correc[ and that he or she is elieible to
,e the homes�ead s�andard deduction on this property. Each undersiened also understands that, by claimine additional homestead deductions
�i'ully, he or she may be liable for back taxes and substantial financial penalties. �
'1 $ienet c Da1c l�elephone
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l�/�/� o I i eiepnone �
ai°''° ,
a i CLAIM FOR HOMESTEAD PROPERTY TAX
a��;; CREDIT/STANDARD DEDUCTION
�,�� • State Porm 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side lor liling instructions.
I, � I ;L ��
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fJAN 2�0 1994
.� �� i✓ �Lw. � certify ihat on the 1 st dyr� ��� t��
our ncipal place of residence ihe following described real property tor which a Homestead P.roperty Tax Credit is hereby Gaimed:
I (We) owned ❑ Are buying under coniract � . � . . ' ,
Have a beneficial interest in the entity that is liable for ihe property taxes on ihe property and that owns ihe property or is buying under a conirect.
CONTRACTRECORDED -
It buying on contrau, Fee Simple owner's name . , - .
Recorder's oHice where crontraa is rewrded Record number Page
Township
Parcel number Legal tle!
n� q-b��la7-oo
li any portion ot the residential structure or the land not
of the property utilized m produce income.
PROPERTY
(ciry, fown,
one (1 � acre that immetliatety surtounds ihai swcture is osed ro produce income. descrihe the use and portion
PROPERTY OWNED BV ClA1MANT IN OTHER COUNTIES �
Coun[y Township Gounry Township
�certify the above statements are true, correct and complete. Si of dai m
r ss �number and street, ciry, siate, ZIP code)
1. /1 % 6 Ai'�1 �i�%�' _ � S� � � ,6 %o
ASSESSOR USE ONLY TRUE TAX A§SESSED HOMESTEAD NON-RESIDENTIAL
� VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately
surrounding residential improvements. (��
Other land (z)
Total land (line 7 plus line Z� (3)
Dwelling (4) -
Residential improvemenis
Garage (5)
Other improvements (6)
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line 7� (g)
I hereby cenify Ihe above is true, correci, and Signature of Assessor oare signed
�� Mmplete.
ying aaion - Signa;ure ot Audimr Date signed
;r
79_Pay19_
Lesser ot 1/2 Homestead
Valuat� or 32,000
DEDUCTION ALLOWANCE
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