HomeMy WebLinkAboutHomestead_Coomer (15)° CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Slste Form 5173 (RB / 4-03)
Rea�iDed by Me Departr�nt d locel Govanmmrt Finaxe
INSTRUCTIONS: See �swras dda kr fHrp irY�ona
�FORM � YEAR
� c �
MAR 0 6
� (we) U 1 l " �`^ ."r
certify (h"et on � st day of March, 20
I(We) occupied as our principal place oi resi Ihe following desaibed real property (or which a ��d��hyA91�T� is hereby daimed:
�e) owned ❑!ve buying un r wntracl
� Have a benefidal interest in ihe entiry that is liable (or ihe property taxes on the property and Ihat owns the property or is buying under a wnVaG.
I( buying on conirad, Fee Simple ownefs iwne
Remrdefs oifice where mntracl is recorAed
���. ,�k����:,�tri't��it�...�'�-i%c�i'��'.�Ctx°„
Counry rownsttip
Lega�
If any poAion a/ Ne residentlal structure w Me land nM
of Ne property utilaed tn produce incortce.
) aue that
Record numher � Page
iating aistrict (tlry,
Is the propert�y �in q-uestion:
}[,� neal properry ❑ MobOe Homo (/.C. 67.7-n
r�
�unds that swcwre is used to produca inmme, desaihe the use and portlon
. ..._
�'a;i�-�_1�:du`c��3{,�;'#�`:STANDARD;OE�UCTION'ALLOWANCE�,._..w. � • b�"'``� ""-`"
� - _�.
� ''� �3��.a+3'�..+m'�`-�^:��i2�'u"��`-�.:� �.t�_�.v
20_Pay20_
Lesser of 1/2 Homestead
wuatan a 535.000 5
SgnaWre of Auditw � Date signed
•
Gibson County Auditor
101 N Main
PRINCETON IN 47670
SUTE fOAM aI'MI�/i'�"1
ik NtfJIfORVZN
�AlAAIHmBY }1R OV aRMEViCF LOG�L C-0�4R.`MFAT iQ:A\CEK'61.1 `_-1.1
lndividuaL and marricd roupks a�e limiied to onc homcueaJ aandaN dnluaiun. As thc receipt ol this deductan bccomes
more bencficial, thrrc is more incentn< dun e�er (or home:teaJ fraud Ilamn;ead imud cauca hi�her ta� bills (w all: thereforr.
HEA 134-i-?OU9 requim u�pa.m who �eccire �he hwnestead siandard �kvfuc�ion m.erify tha� �hey ue eliciNe io �ecenr �he
brnePo an1 ro prm�iJe aJJitional iJentiipin_ informatiun necex'vrr io allw� counq' gmemmrnl ro bener moniror homese;W
filir�-.'17tis inlomulion x'ill br Aryv conf�!wial and can only M` artt�md h}' awMrimd mnnty n(Ticials. Th< Ikpanment nf
lucal Gmrnvnem Fivirce ��ill ux this in:ormation to cream teds that �cill h-10 ramn officialn elimiwm homcstcad &aud_
910
Rhonda J Coomer
305 N Race St
PRINCETON IN 47670-1823
I�I„II���I�II��I���III������III��I���I�I��II�II����I�I�I���II
Taznacer Name Prnpertc Address
Coomer. Rhonda J
305 \ Race
I'rince�an IN 47670
State Parcel NumAer Leaal Descriotion
�' 26-12-07-203-003.267-028 01s-o3267-0o NS LOT 2 PT R7
This form MUST be retumed to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
�� �
Oaner I First Middle Last
P� � Coomer
ine Address (numbcr end st�cet, cily, smte, and ZIP code) � Seme as propem eddress
3c�5 tv Ro,ce P �r«�ar �� '-+1 �
$ocial Secur7ly Number �last 5 di¢iLS) Ihivds Lice2m/Sute ID Number Qazi 5 digiLS) Oiher (please spttifi� in Pan 4 below)
,�,
Spou;e First A1iddle Last
Mailin� Addrcss (Numbcr and scee4 ��)'. siate, and "LIP code) � Same ns pfopmy addrev
Social5tturity Numbcr (lazc 5 di¢i�s) Dri�•crs Limnsc/SUte ID Niunbcr (laa 5 digits) Othcr (pleue spccify in Part 3 bclow')
_ sm�
1
Fach undersicned certifies, under penalty of peryury•, that the above and foregoing information is we and corrzct and tha[ he or she is eli4ible to
receive the homesiead s�andard deduction on this property. Hach undersiened also understands that, by claiming additional homestead deductions
unlawfully, he o; she may be liable (or 6ack taxes and substantial financial penalties.
Ownn 1 Si�mawrc Dete Telephonc
�OO�e?� N—�3- � 0
Spousc Simamrc pa�e Tcicphonc
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