Homestead_Cox r
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r clan MIMI53l W Sll'r 54M1 MEASURER?O&M:}IA
',MOVED BY AtUE W D elf MYVRLxlx:ON PtISMIBIED BY TM DEPAATYfNT Of LOCAL CAVERYMMT FINANCE IC 41.1-2:-rl
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples ate limited to one homestead standard deduction.AN the receipt of this deduction become>
more beneficial,there is more incentive than eser for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
® HEA 1344-2009 requires taxpayers who recei'e the homestead standard deduction to verify that they are eligible to remise the
benefit and to provide additional identifying infonnmion necessary to allow county government to better monitor homestead
fling.This information will be kept confidential and can only be accessed by authorized county officials.The Depanntent of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
—. Cox, Clara A
122 lox 46
Oakland City IN 47660 /\I /
5605 �Gr
Clara A Cox
1858 S 1200E State Parcel Number Legal Description
Oakland City IN 47660-8113
1r1u11ut�P�lnrlluilntlnlnnllntllnlInitltlttlttttill 26-14-19-203-000.160-006 Cl 00160-00 WATT ADD SEC A 14
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
�g Address(number and strut,city,state,and ZIP code) - _ U Same as property address -— -
/351 5- /0700 g- eedi4 i / - SI7iZ 4
Spouse First Middle Last .
Mailing Address(Number and street,city,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)
slue
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 eliuible 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 Sign ture Date
I
p CLAIM FOR HOMESTEAD PROPERTY TAX FOR
YEAR
CREDIT /STANDARD DEDUCTION HC1
` u ` State Form 5473 (RS/ 10-01)
Prescribed by the Department of Local Government Finance r�
INSTRUCTIONS: See reverse side for filing instructions. MAY 1 % 2002
',CERTIFICATION STATEMENTi�. _
I (We) eU , ' h . Tst dd1V� lQgt , 20_
(We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby daimed:
�i(We) owned ❑ Are buying under contract
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.
t sF x
CONTRACT' RECORDED- .",?;= sx'yK�ar.T'i5r.'.
If buying on contract. Fee Simple owners name
Recorder's office where contract is recorded Record number Page
P,ROP,ERT.YDESCRIP.TION ' '7�...t" .1. �azrs..,•za�z�'S�.x}ria'�`'��"w' i,�€�3_F:,:
County
TW ship
Taxing s ' t N town, low(ship)
`uestion:
Parcel number
Le al descd lion Is the property in
W 3 -00
I VReaJ property ❑ Mobile Homo (I.C. 6-1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
Land not exceeding 1 (one) acre immediately
. F?t+... �. �> GPROP ,ERTY,OWNED�;BYCLAIMANTIN,OTHER COUNTIES ..�� -.- '„,,,,�e~_�3_r,:?(:;5's.`{y
County
Township
County Twvnship
I hereby certify the above statements are true, correct and complete.
I0ighature of apq
ydress (number and street, city, state, ZIP code)
A , Y�5t� `'TRUE�TAX
jN� ?,ASSESSOR�USEONLY *'
�� I•
_& s �x
ASSESSED VALUE
* e a
°- HOMESTEAD
NONLRESIDENTIALr -�
_
� mac. ., i"gt et�`'r= ��'= �Y}vea,'xr...o
;F!a: VALUEl�t.`.;:
.�ATr100 %;OFieT.�V.'S
s
i...+4 VALUE...` .`TC.,ii?-
...w
4s�VALUE,dsss`js�Ech
Land not exceeding 1 (one) acre immediately
Valuation or $6,000
S r of Audit
surrounding residential improvements.
(1)3
IN A"
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`
Other land
'z ➢"r ;-14�t
(2)
,;
Total land (line 1 plus line 2)
(3)
Dwelling
(4)ti
t by''�ri3 a Y)•s.�ei �.cF '�
}X, a�(
Residential improvements
Garage
Gana 9
( 6 )
'�`t��-TS'"'
, t Z
Other improvements
(6)
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is We, corned, and
Signature of Assessor
Date signed
complete-
Verifying action - Signature of Auditor
Date signed
�, >14. �`> - -7�-" `- , STANDARD :DEDUCTION'ALLOWANCE?"z'�:
..
20 _ Pay 20
Lesser of 112 Homestead
$
Valuation or $6,000
S r of Audit
Date signed
IN A"
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