Homestead_Coomer (20)�a mrt4
a� "� .: CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
.b '
7'
�,,,�,` � State Form Sa73 (R2/5-92)
,.�.
r`!(JSTRUCTIONS: See reverse side /orliling instructions.
FORM . YEAR
HC70
I �We) • U � certify that on t�heA y7st day of March; 1B_
I_(/We�ccupied as our principal place of sidence the following described real property for whicb a Homesiead Property178qCr�d �s �e�y Gaimed:
�I I(We) owned ❑ Are buying under contract ' / � /�
`Have a beneficial inierest in ihe entity thai is liable for the property taxes on ihe property and Ihat owns the �erty ords.�uying'n�der a yiyitra¢y
�- - - � CONTRACTRECORDED � ' � ° �
If bryfng on contract, Fee Simple owner's name
ReCOrder'S ofliCe where wntract is remrded Record number Page
PROPEHTY
Gounty Township T�in dis .' t .(bw , n5M .
I mb ^ L al tlescription
J
It any ponion o the residential strucwre or the land not exceeding one (1) aae ihat immediately surwunds that structure is used to produce income, describe the use and portion
of the pwperty utilized to produce income.
� PROPERTY OWNED BY CLAIMANT IN OTHER
Counry Township County
I hereby certify ihe above statements are true, correct and complete. � vre of dai'm�ar
-ess(nymberandsbeeGciry,state,ZlPmdP) �� � �.
ASSESSOR USE ONLY
Land not exceeding 7(one) acre immediately
surrounding re5idential improvemenis.
Otherland
Total land (line 1 plus line 2�
Dwelling
Residential improvements
Garage
Other improvemenis
Tota� improvements (line 4 through lina �
7otal value (line 3 p�s line �
I hereby certify the above is true, correa, and
complete.
Veritying action � Sgnature of Auditor
TRUETAX I ASSESSED
VALUE VALUE�
(�)
l2)
(3)
(4)
(5)
(6)
(�)
le)
Signature of Assessor
HOMESTEAD
VALUE
Tawnship
2� L O
NON-RESIDENTIAL
VALUE
Date signed
Date signetl
� STANDARD DEDUCTION ALLOWANCE • � � - � -
19 _ Pay 19
Lesser of 1/2 Homestead �
Valuation or 52.000 S
SgnaWre of Audimr Date signed
e
.
Gibson County Auditor
101 N Main
PRINCETON IN 47670
SIAiE if1AM �� W �R'/ YNI
.V iP(T'EI� BY.�l�IF NMADOF
t11E�tiL'�lR PoM1V 11.�
Individuals and ma:riN couplcc are limited �o ore home�caJ sandaN JeAunion. As �hr rtttip� ot this dNuction become�
more beneficial, therc is morc incen[r�e thm e�er for home.teacl fraud. Ilomr.teacl fraud causes higher tas 6ills (or all; therefae.
HEA lili-?009 rcquim uxprym who receire Ihc haneviced sundard JNuaion w.eriFr tlu� �6ey am elicide io mccrve �he
benefii ani �o pnn'ide adfi�io�ul iJentiiyin_ informa�wn necrssan� to allw� cwnq' gv.'emment [o Y.ner moniror Mmenead
filin��. Iliis inlormation x�ill 6e I.ep mnlidemial and can only h aeee.nvl b�� amhmi:eJ rounry� ofTciuls.'Ihe Ikyunmme o(
Local Govermnem Fim�rce aill uK �his infonnation m crcam twls thm will h:lp camrv� officials diminaie homestead frauJ.
797
David L Coomer
526 N West ST
Princeton IN 47670.1438
I�I��II���I�II��I���III������II�I��I��II�I��I���I�I�II����I�II
Taspacer Name Propertr Address
Coomer, David UCynthia
5?6 N N'�st ST
Prinreton IN i7670
State Parcel Number Leeal Descriotion
X 26-12-07-102-003.275-028 01s-o3275-0o OLD Pvw tos PT
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.
� �
Ow First Middle Las�
�fl�,� �.la� �Q �oo�,
ilme Addr6s (number end >umc ciry, sutc, and ZI P code) � Same as property oddrcss
J�a � (�J �,J es� .��e e.'�' ��� /u c e.�ti �iu dl �i7� ^7 v
$ocial5ecuri�' Number flast 5 dieils) Ihivers License/S�
Spowe 1 First Middle Latt
� w�l�iq C,00MeR
Mailin� .4ddres (Number and �vee4 ci�y, s�ate, and "LIP c«ie) e a5 pmperty add+Q
Social Sauriq� NumMr (last 5 digits) Drivefs License/State ID Nwnbe: (la;� 5 dieiti) O�her (plesse specify in Part 4 below�)
_
,
Each undersiened certifies, under penalty of pequry, that the above and foregoing information is true and correct and that he or she is elieible to
receiee the homestead standard deduction on this property. Each undersiened ai>o undemands that, by claiming additional homestead deductions
unlau�fully, he or she may be liable for back taKes and substantial financial penalties.
Own<\ Si�n.we � y� � O T���phon� ( �
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SpouuSip�amm � pzte Telcphonc /
C�-� C�v�.°'.. y - �,-►v ( �
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