HomeMy WebLinkAboutHomestead_Cook (2) ' CLAIM FOR HCOTEAD PROPERTY TAX CREDIT FOR YEAR 19! : .
. • SEE BACK FOR FILING INSTRUCTIONS { °--^
• . S1 .. L• CO-D-� : certify that on the 1st day c
I� .,ch, place of residence the following described real
arch, 19 8 , I, (V1e) occr�ia3 as our princiDali
uL-upnsty for which a Instead Property Tax-,t'K...d:t is hereby being claimed: -
�) U own
gaze buying der contra-^t
0 have.a barfi i al interest in the taxpayer •
��,,rn, County Towrshi
Property Description. in
Taxing District (City own ..cnship) : 0 ,rr-
Parce I1uther I I or 1 dscrioti.nn T. �na,� .
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SIf
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If any portion of the residential structure or the land, not eceeciing one (1) acre that
immediately surrounds that structure is used to produce income, describe the use and portion of
the property utilized to produce imams
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real property: County ' Township
Frry other counties in which individual owns or is buying .
1h jv. certify the above statement is true, correct and complete. ��C `f'!b`�o•
/tine ' / •
f„! o 4� Cyty r fate and Zip Ctdc
74--;�� Street Address :. .
tutor a contract that provides he is to pay the
`,.. *Individual xeshon tarts es is ce, or has a beneficial interest in the taxpayer.
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•property taxes on the resid�:ce,
. - FOR ASSESSOR'S USE. OI•:LY -.
True Cash. Assessed Harestear
Value Valuation . Valuatini
Land not ex u , ch (es•) acreinreciiatelY • • •
stsivurding1 (1) f/a
Other Land t
/
MAR.03 3 1988 • ' (3)
�°�`� . /17/lAW///i % /
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po�iential�I7Wi�terts Dwelling (4) �( l
AUDITOR • Garage (5) • —
Total (6) . /C20
ether Irrprovermul ,/ ///G,
To • 7iroroverents - Line (6) plus (7) emuals (8) (8) __
the above is true, correct, and ccr_plete.
Dane
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Sire of Assessor
.� - � - ACTION BY AUDITOR -. •
rporov : d L . C.. •
Date: ih 6-1-. Si (cage .
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ATP SIAM WERM!IMIR:I I5RO TRFDC&ScA EOM:}IA
nrPROVED BY StaL BMRD OF.Arr UNTt.bw PRFSRIBED BY 111E DEPARTMENT OF LOCAL OMER:AIM,FIANCE lc VI.I-L-tl
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead aaandard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than net for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1344--2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receve the
benefit and to provide additional identifyir information nec'essiry to allow county government to better monitor homestead
filings This information will be Atli confdxauial and can only be accessed by authorized county officials.The Depannem of
Local Government Finance will use this information to create Beds that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Cook, Audrene
107 N Indiana ST
Hazleton IN 47640
45
Audrene Cook
102 N Indiana State Parcel Number Leal Description
HAZLETON IN 47640-8814
26-02-29-200-000.184-019 014-00184-00 E ENLG 51f33PT
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
L ,qua c K� mot.
�te Address(number mid street.city,state,and ZIP code) - —— - Semc m property uddrss -
r o a ry.. d l ra—rz A a -L ,r .. 174-7 1:2
Spouse First Middle last
cc EAc�d
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 spaify in Part 4 below)
sae
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 j J /Date
Spoof Signature Date Telephone
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PART 4: ADDITIONAL INFORMATION
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