Homestead_Coxmq
CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT/STANDARD DEDUCTION Ncl
State Form 5473 (R5 / 10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
F—YEAR
14;0
'CERT
47 IFICAMON STATEM
I (We) jLAk f certif th on �1�stf arch, 20
led as our P' At:�z
w 'IBS
L1 Are buying under contract
a;
I (We) occ led as out principal place idence the following described real property for which 5 od'R hereby claimed:
❑ I(We owned ui: 0,4 COL
Olave 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 owners name
Recorders office where contract is recorded Record number Page
PR(jPEF&Y,61NNEDBY CLAIMXNT
zPROPERTY.IDESCRIOrrION
Cotinty,
Township
County
Taxing district (city, town, township)
I hereby certify the above statements are true, correct and complete.
b
Lega
pt
R�f ?*;
the property in question:
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1 -1 ❑ Real property ❑ Mobile Home (I.C. 6-1.1-7)
If any portion of the residential structure w 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.
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PR(jPEF&Y,61NNEDBY CLAIMXNT
-TRUE-TAX:4-1-4
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Si nature of claimant
VALU E iQ
tress (number a e' ;� z`Pcod, / X
Z, ir 169 Z), Ilaimile-4r�
-z-/v q-7&,v6
MIA I
Z, STANDARDMEDLICTION
-TRUE-TAX:4-1-4
ASkSS�6-.�ALbE
R_0M_ES'TE_A6�
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ON-RESIDENTIAL
t��:6SE�Sdii:OSEONLY�-*I�fz�����;Z,-
'CL, � VAL E
OF 7TV
VALU E iQ
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Land not exceeding I (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (fine 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 Amclitor
Date signed
Z, STANDARDMEDLICTION
20 _ Pay 20
Lesser of 1/2 Homestead
$
Valuation or S6.000
Signature of Auditor
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' •• SUTE FORM!YW IR_I S Pt TREASURER FORM 7.3-1A
•pRrwEn BY5rxm POARD OF'VYYR TS.biy PREAAIBED BY IDE OEPMnetrw LfRAL IXcaueolT W:M[EIc41.1ri1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ner for homestead fate].Homestead fraud causes higher tax bills for all:therefore.
. . HEA 1544-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receve the
benefit and to provide additional identifying information nece<San'to allow county government to better monitor homestead
filings.This information will be kepi confidential and can only be accessed by authorized county officials.The Depannunt of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Cox, Jacob H/Melissa D
RI I
Hazleton IN 47640 ( L
503 a op
Jacob H Cox • 1
6639 N SR 65 State Parcel Number Leal Description
HAZLETON IN 47640
26-05-01-400-003.165-017 0009-03165-00 PT S 1 1 10 LOT 5PT 9.629
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Jacob Henrl ox
hg Address(numbei nrid sued,city,state,andZIP code) _ / _ __ — f Same as property oddr¢c--- - -. -_
&t39 N SR O5 flazle_-I on ZNI/ Y y -](Ao
Spouse First Middle Last
Mg /i 55 C._ Dawn COX
Mailing Address(Number and steel,city,state,and ZIP code) 1I� Same as property address
(L (1 39 N SR (, S 1-f0.zlelon ZT// t1 c17L, 'IO
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 Sign Date
, /
PART 4:ADDITIONAL INFORMATION
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