Homestead_Cook mo-
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✓PRrn'ED BY CHit BDSRDnF MrgmTc Zing PILYMmFD BY Inn Dn./RTM:EC Or LOCAL C-0SFRNNn3 FINANCE M 6-1Y224.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead randanl deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than eser for homestead fraud.I lomestead fraud causes higher tat bills for all:therefore.
HEA 1344-2009 requires taxpayers who reecho the homestead standard deduction to verify that they arc eligible to reeeene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kepi confidential and can only Lv acros ed by authorized county officials.The lkpanment of
Local Government Finance will we this infotmmion to Breatc tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Cook, Wayne E /y225 -//506-//50 E
R3 13ox 24 B
Oakland City IN 47660
5539
Wayne E Cook
1832 S 1150E State Parcel Number • LeEal Description
OAKLAND CITY IN 47660-7622
' I it II II II I III I I I I II V I I I 26-14-19-103-001.052-006 003-01052-00 PT SW NW 1&2-8.484 AC
to nl t nl a setnt t tuft 11l a Matts C-1
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
erg Address((lumber and street,city,state,and ZIP code) Sntne ra property address
/ Si7Z S -//S-0e n.4K)-4 /vbc;f tN w J7 & /)
Spouse First Middle Last
r
-�_
Mailing Address(Number and street,ciy,state.and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
-. sots
PART 3:CERTIFICATION
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to
receive the homestead standard deduction on this property.Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Signature Date
•
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 IRS 14-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
t: ?M5
U .
w4liit�
bl- M(I
I (We) /I-/ L"Itoz a certify that on y of 0-9DR
I (We) occupied as ot/principal place of residence the following described real property for which a Homestead Property Tg 8(�JOILreby claimed:
t��Ne) owned ❑ C3 Are buying under contract GIB 0
0 Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
PROPERTY..DESCRIPTIONf_
County Township
County
Township
Taxing dins(city town, townshlp)
1 �96Z.14�
Siggature of claimant
Parcel number
003-(516,
Leg ascription
Tk /V
(a the property in qumfi6n:
I
U EZ_ tAZ§An ----
- ce)
i5 hi Al
-42:Real Property
❑ Mobile Home (LC. 6-1.1-7)
If any portion of the residential structure or the land not exceeding we (1) am that immediately surrounds that structure is used to produce income, describe the use and portion
of the property Utilized to Produce income.
v
S�
/-/ dva- 406
-DEDUCTION 'ALLowANCE-
!WZ%��STANDARD 4,
20 _ Pay 20_
Lesser of 12 Homestead
Valuation or $35,000
Signature of Auditor Date signed
County Township
County
Township
I hereby certify the above statements are true, correct and complete.
Siggature of claimant
Wass (number and streef, city, state, ZIPoode)
-DEDUCTION 'ALLowANCE-
!WZ%��STANDARD 4,
20 _ Pay 20_
Lesser of 12 Homestead
Valuation or $35,000
Signature of Auditor Date signed
TRUE TAX iASSESSED
_m*VAL
NALUE
HOMESTEAW'�?�z4NONIIESI
D- EN, T [AL:A- '�5
U EZ_ tAZ§An ----
Land not exceeding 1 (one) acre immediately
surrounding residential Improvements.
Other land
(2)
rt
Total land (line I plus fine 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
W �k
(5)
improvements
(6)
,?Ibex
Trial Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
-DEDUCTION 'ALLowANCE-
!WZ%��STANDARD 4,
20 _ Pay 20_
Lesser of 12 Homestead
Valuation or $35,000
Signature of Auditor Date signed