HomeMy WebLinkAboutHomestead_Coomer (24)CL614lNJ FOR HOMESTEAD PROPERTY TAX
CREDR/STANDARD DEDUCTION
S�e Fom, s�t73 (R7 � s0�
PreapbeA by Ihe DapeNnan! af Loml Go+arcnml Franm
INSTRUCTIONS: See ieverse side fa filing insbucGOns.
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FORM �R
C10
�(We) '/�6-'� � L�Q��I�� C¢f@fy tl18�1�M2fCh� 20_
I(We) xwpied as ac prindpal pla� of resdence ihe fo8owing desabed real popeAy for which a HanesMad Propaty Gedd' ereby daimed:
���� �� �� b� ��g �� GIBSON COUNTY AUDITOR
Have a benefidal mterest in Me entity C�at is liade fiw IAe poperty ta�ces m the pope3ty and C�at owns the property or is 6uy'vg under a mntraci
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tt huy'sg on mitrecl. Fea Sinq�e awmefe iame - --
f�mCefa dEm Wae mr0ati ia ramrded Remd numher Page
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TonNup
Pa�cel nunber , Legal d�aipEm ; c t' b tl�e poperty n quas0on:
b-I 1-� 3- a �4-�D- Q=Od $' rn`��viuWCCm► 0�� ❑�b � a�. 6,.,-n
tl en,, porOni d Ihe residaqial �re v the ta�o nal o¢eedinp ona (, � aoe tlm, inn,edatel7, c��.,da Mal af�va is �sad fn,�od� nmma. dasabe the ,ae and ,vtim
d��„�m��. '73
1 � ; � -. . . . : „rY� {� :,, .TfriIE.TA7C � ASSESSED VALUE HOCgS7El1D' , , �j NON�tESID6iTiAL` r'', 'i�".
, .� �s' ,�ASSESSOR USE OlILY � . �� � i; I ? y�,�E�, ��„ . , 'AT 1007G OF TTV : �,;VALUE ss >i 3 �, i 1, ,s.,l�n V/iLllE. .Y!i�!,� : g„�
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Lend f10t el�ee6lg t(One) aRe irtn�ediatelY � n' j,�w i- '.. �•�, }�q �.., �",�� �ia
5imwaMiq residenRal ir�ok.�rt�ents. ( � �v �, 4?i's,;s r n�3'Ya�i'ro�."-7'�D:i
OUrer lard (y) � . . J : � �
�- :. ar i t..
Tdal land (I'are f oluslore � �g)
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Dwe6 4 �": s4= $s.��a�,r,� t�r`a'�'�,;,n �,�css°/a'�
ResAential irtiprovei:ents orAnrwally �9 � 1 c
�SEd MO�C / M2fY3�8f�lEd H01f1E o� �{�i J e ..r. ��fi;..Y;�;
+(a3�C �rj� }�°l,�+s r Ntr 1Nsi ��';g ��+�
r!"�3f �,A�"� fliii'f'I'.��
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�i�l@lOflpfOVCR1E(Ii5 �s� �'. ,��.�. �: �NSt��
.i:<.M� F�',5f
Rfal'vnptwar�enis (fine 4 Hvou�A 6ne 6) �7�
Tdal value (1'vre 3 pds 6ne � ig)
I heieby certiy ihe above is hue, oarecl and SB�a of �v Date s'q�ed
mmplete.
�M^B ealan - Si�e4ae af nadmr Dam sipned
�,; ' ? r s.. :STIWDARD DFIIUCTON'liLLO1NA!!CE r "' .�.'vs+' +t t�' x .�`.55 �. �:F^J�i!
20 _ Pay 20 _
Lesser oi 12 Homeuead
V�uatian or i35.000 S
Si�ae ot Au6mr DaU sipned
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S�ATE FORM S1569 (R'JB-09) TREASURER F02N TSIAI
APPRO\'ED BY' SfATE BOARD OF ACCOUYIS. 2009 PRFSCRIBED BY T}IE DEPAAiNFNI' OF LOGL fA\'ER:VMEhT FINA.\CE IC61.1-33-8.1
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more inceuti��e than ever for homestead fraud. Homestead fraud
causes 6igher tax bills for all; therefore, HEA 1344-2099 requires taxpayers �vho receive the 6omestead
standard deductiou to verify that they are eligible to receive the benefit aud to provide additional identifyiug
informatiou necessary to allow county� go��ernment to better monitor homestead 5lings. This informatiou
will be kept confidential and cau only be accessed by authorized couuty officials. The Department of Local
Government Finance will use this information to create tools that will help county o(ficials eliminate
homestead fraud.
��� � �
Tamarer Name Prootrn' Addms Stah Parcel \umber Leeal Dncrio[ion:
Fred D Coomer 1228 Darwin Ave � 26-11-13-205-000.029-028 019-00029-00 MCKAW SUM 73
PRMCETOh M d7670
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N DIAL� PRINCETON IN 47670
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Ovmer 1 First AIiEEIe '^
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MaiGng FEEress (nurtEer aM Wee4 tlry. state aiM ZIP mEe) ❑�� as propaty aaaress
smai senmry Num:m (wsi s aqi�s) omers um�se sm�e io Nurtae� (mst s aiB�ol ss. aner Wease so�N � aan a bdow)
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_,�wse FuSt NiEtlle Last
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Ma�ing AdCtess (mu`EC aM svGeL tiry. stale antl ZIP cntlo) ❑ Same as G���Y atlaress
Soaai Semiry rNmo�s (msi 5 a�pi�s� Dmeh �cenu State ID Nurttu (wst 5 aie�o) sxe ou�c (pPase speah in Pan a oeivx)
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� Each undersigned certifies, under penalty of perjury, that the above and foregoing infortnalion is We and correct and that he or she is eligible to receive Ne
homestead standard deduction on this property. Each undersigned also understands that, by Gaiming additional homestead deduGions unlawfully, he w
she may be liable for back faxes and substanfial finandal penalties. .
Owna 1 5� ture �^ Date TrJed�e
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Spwse Sigiuwre Date Telepw�e
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