Homestead_Cox (10) CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION _
2143! HC10
Slate Form 5473(R8/7-07)
s
Prescribed by the Department of Local Government Finance i■ i r f
• 1 i i�.
INSTFUCTIONS:See reverse side for filing instructions.
_ __
. (� .teytn•� <<.. -, �_:. `t .. , r :,' ;•CERTIFICATION�STATFMENT_..+ ..-,-.. . 4. .z ' � r,.>.,
I(We) ►,.4 /1 1 erral. . .n/n at_ certify thatk4he 1st�a March, 20-
I(We)occupied as our principal place of residenc:f e following d scribed real p •perty for ich a Homestead Property�redit itstereby claimed:
GIBSON COUNTY AUDITOR
r'1 I(We)owned ❑ Are buying under contract
.-lave 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.
"-'312 1 r< s •..: .: . . ;.,._r. :,•. :i..-: ' -: CONTRACT.RECORDED
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
:, te t r1;,,,. _o-:= -: 1. ._ _ .:'PROPERTY-DESCRIPTION. '-:`: `r i'' " . . _ -. <'
Coo ty r Township Taring district(city.town township 9/ T
4)4 1 4 •
Pamel&W nut bar 3-II-1 oo� I .Leg I ,00(7 I Is the pr ea property ❑ Mobile Home(IC 6-1.f-7)
If 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
property utilized to produce income.
5,: e ?w,rt - 4 ' � .4 . •..,:- :PROBERTY,OWNEOBY CLAIMANTi iii OTEmR`C
OUN:tits: ` - ". �' : "'- - ,_
County Township County Township
I hereby certify the above statements are true,correct and complete. Si re of alma
�ess(nu band'free city slate.and ZIP coif e) �� r r /� i � 1
r 3 'nt,. ASSESSED VALUE HOMESTEAD. I NON RESIDENTIAL"
f .`ASSESSOR USE ONLY TRUE TAX VALUE AT 100/o OF TTV -. VALUE h r3__=_VALUE t :z�--x
Land not exceeding 1 (one)acre immediately
surrounding residential improvements. (1) - - -
Other land (2) -
Tctal land(line 1 plus line 2) (3)
Dwelling (4)
Residential improvements or Annually
Assessed Mobile/Manufactured Home
Garage (5) '":::::'-`...'7,
Other improvements (6)
Tctal improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
I hereby certify the above is true,correct,and Signature of Assessor Date signed(month,day,year)
complete.
Verifying action-Signature of Auditor Date signed(month,day,year)•r t1 ui._. 12. ..3'O r`-0.' 1 ?-;STANDARD DEDUCTION'ALLOWANCE ''- )- j -
—pay 20_ 45.000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 1Y2 44,000 for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead Valuation $
or
43,000 for 2009 pay 2010 40,000 payable after 2012
-9igr ra nor '` ' 1 Date 6tgn5mopy,day-yygr)
STATE FORM 53569(R'JS09) t • Y nn,e- 4i. . (a%-� pg�` ABEDB' }.TMEDEPTRTA . OFGee-et
IA(.AL CAYFJ[:ME�T FTA.�CEIC61 ..8I
k. 'OVED BY STATE BOARD iy ACCOUNTS. .. '�' `� "� r
PORTANT NOTICE TO.`HOMESTEAD PROPERTY OWNERS
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 ever for homestead fraud. Homestead fraud
liauses higher tax bills for all; therefore, HEA 1344-2099 requires taxpayers who receive the homestead
s dard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
information necessary to allow county government to better monitor homestead filings. This information
will be kept confidential and can only be accessed by authorized county officials. The Department of Local
Government Finance will use this information to create tools that will help county officials eliminate
. homestead fraud.
PARTI:-PROPEwry 17.7.- EORf0IA ION, 1
tie Property Address State Parcel Number Lent Description:
Robert A Cox Ft I Box 64b 26-13-11-100-001.411-006 003-01411-00 PT N 11-2-9 1.00 AC
Oakland City IN 47660 'y/ C-1
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 •
PART 2: TAXPAYER INFORMATION •
Owner I First Middle last
johtiedi- 1q. co ›.6
Mailing Address(nutter and street city.state and ZIP code)
/ Rd //'// / I Same as property�address s[ no
• First __- Middle - _ _ _ __ .-_ -_— Last
_ __ _
deen � r 114 C'ox
Mailing Address(number and street city.state and ZIP code) ^
_v I Same as property
%
9 7L 6 la 4.
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 1 Signature Date
PAR'r4:AgDITIONALINFORMATION - .
0