Homestead_Cobbn,Eq CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
CREDIT /STANDARD DEDUCTION R 1 Q�
State Form 5473 (R2/1 -90)
.INSTRUCTIONS: See reverse side for filing instructions.
q i99!
CERTIFICATION STATEMENT
`(We) certify that on the 1 si dam °1��
(We) occupied as our principal pyace of residence the following described real property for which a Homestead
Property Tax Credit is hereby claimed: LQ–T�(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 orris buying it under a contract:
CONTRACT - RECORDED
If buying on contract. Fee Simple Owner's Name
Recorder's office where contract is recorded Record Number Page
PROPERTY DESCRIPTION
County . Tow Taxi n trict (City, town, township)
Parcel Nu ber Legal Descriptio
V15 5 IS$oO ( � . 'SI;) 0-3-1 1. o_o A C
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that struc-
ture is,used to produce income describe the use and portion of the property utilized to :produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
ounty Township County . Township
I hereby certify the above statements are true, correct and _ Signature
complete. - - -
Address (Street, number, cit . stat and ZIP code)
3 Igo X r
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON- RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other land
Total land - line (1) plus line (2)
Residential improvements Dwelling —
Garage
Other improvements
Total improvements - line (4) through line (6)
Total value - line (3) plus line (7)
-
(1)
1991 Pay 1992
19 — Pay 19—
Lesser of 1/2 Homestead
(2)
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Valuation or $2,500
(3)
Valuation or $1.500
Valuation or $1,500
(4) - -
— - - -
- -�
Signature of Audit o
p.
(5)
(6)
(7)
(8)
1 hereby certify the above is true,
correct, and complete
Signature of Assesor
Date Signed
Verifying Action - Signature of Auditor
Date Signed
STANDARD DEDUCTION ALLOWANCE
1989 Pay 1990
1990 Pay 1991
1991 Pay 1992
19 — Pay 19—
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Valuation or $2,500
Valuation or $2,000
Valuation or $1.500
Valuation or $1,500
Signature of Audit o
p.
Date Signed
3.19 -4
TAt FORNgYU,RL4ut IR:ASORLR RU1LV tSIA
APTnnFppl T.VE301Rp Oryln,NISN.r1 rska(t 0)M nILp rAglMEvn FIcL:LLroVERMONrIL\AM(EK'n1.I-r+.1
'Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS •
f 101 N. Main Street Individuals and married couples ale limited to one homestead standard deduction.As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial.there is more ineenlise than ever for homcstmd fraud.Homestead fraud causes higher ax bilk for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to serifv that they am eligible to teethe the
1• benefit and to pwwide additional identifying informationtneressan'to allow county government to baler monitor homestead
filings.This information will be kept confidential and can only be accessed by authorized aunty officials.The Department of
Local Government Finance will use this information to enatc tools that will help county officials eliminate homestead fraud.
PART 1:PROPERTY INFORMATION • - ' -• • . •
Taxpayer Name Location Address
Cobb, Dennis MlJanet A Life Est/Tina
Sue
• 7384 S DIVISION
MACKEY IN 47654
867,4 - jppj�� ��IIII IIII IIII IIII IIII IIIIII
Dennis M Cobb as h �T II�I�III_�III I II��III�IliI�IIIIWIIIII l0llllhI_II IIIIuIuII II II_�II�II_IIJIOI IIII
7384 S Division St
OAKLAND CITY IN 47660-7746
Il1lrllrl1IIIIIifiIIf"lIIII' '1II1'I1"11I1'1IIII1'lll1tl11Llll1 State Parcel Number Legal Description
26-20-14-303-000.006-002 PT SW 14-3-9 1 AC
FILED
SEP 27 2012
This form MUST be returned to County AwgjLW QfI+ „TOR
Please do NOT send this form back with your tax payment to the county treasurer.
•—r -- — ; P4R 2:A. 'A • x O 14 • I • ' •
er I First Middle Last
,TP'` C
Mailing Address(number and street,city.state.and ZIP code) N,.Same as property address•
3 'y 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) Driyeis License/State II Number (last 5 digits) Other(please specify in Part 4 below)
I l J s..
• • 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-Sing ature Date
Spouse Signature Date Telephone //
PART 4:ADDITIONAL INFORMATION .