Homestead_Cook •
S1 ATE mane 53iwo R:rvwl TREASURER FORM 13-IA
ArrrfWED BY arvTE WNW IN'S OINTS.Inr PRESCRIBED BY 111E DEPARTMENT OF LOCAL GIwtR`MrWT MQ:.ANCE ICr-I.I-t4I
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
IP more beneficial.there is more incentive than eser for homestead fraud.11omestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who reccise the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information neces r v ro allow county government to better monitor homestead
filings.This information will be kepi confdemial and can only le accessed by authorized county officials.The Ikpannrent of
Local Goverment Finance will use this information to create cools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY LNFORMATION
Taxpayer Name Property Address
: e;ook, R
t Box 72
/ n Q
c . c.s-TA Oakland City IN 47660
3192 1l� LQ�V\O jC6t? o L1 (`275.
Jerry R Cook D M /6 41 A ktC KQ 5 i
tr72 State Parcel Number Legal Description
OAKLAND CITY IN 47660-7657
I tittlitt tltlltttllf filtttlf ttlf llfftlf ltlttt lit tt lltt ltlttt il 26-20-02-201-000.514-001 001-00514-00 PT NW NE 239.1013 AC
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2:TAXPAYER INFORMATION
Owner I First Middle s'. Last
��r rle. ears
a� C
•tg Address(number trcet,city,state,and ZIP code) ume as property address
L 6. i 2. 5 . ST-A-7- CO 5 '2 petklaau iv, 4-(26,G1 o
Spouse First Middle Last
•
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as properly address
Social Security Number(last 5 digits)_ I Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
_ seas_ _
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 Jr Date i
• L
( t 5 5 6 4 C o w n l y re Ca.5 L4 ,- c rl`
(12(4 e. t A)lA1M hNA I
e+ rtn t CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION C
t r State Form 5473 (RS 110 -01) j-et7i
Prescribed by the Department of Local Government Finance F LJEI
INSTRUCTIONS: See reverse side for filing instructions.
n
CERTIFICATION STATEMENT "of I (We) ertify lh he 20
I (We) oco led as our cipal place of residence the following described real property for which a Ho s claimed:
dRP �J
- 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.
I
c+i :'ri'X.a., 'T..+ - -��"• " `.' CONTRACT:RECORDED t:_ =` .• �-,.- - =a
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
-PROPERTY OWNED BY CLAIMANT IN OTHER- COUNTIES
_ -
PROPERTY .DESCRIPTION
Cou
Township
USE ONLY _ s
U°`r:. wit �, r::W'�•t.":r^_ a.. '_,-
T i isldd
hereby certify the above statements are true, correct and complete.
Si nature of claimant
r+?ANON-
}:-VALUEt,,;,� =.-t;:
�ress (number and street, city, state, ZIP code)
3 e J Y, -2 -), +:1 44 Ga
P number
Legal description
tiro
Is the property i uestion:
,/�)
u`-'
Mobile ❑Mobile HOmo(I.C. 61.1 -I)
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.
(2)
e71-601
-Q
-aol-000.
d/
-PROPERTY OWNED BY CLAIMANT IN OTHER- COUNTIES
County
Township
County
USE ONLY _ s
U°`r:. wit �, r::W'�•t.":r^_ a.. '_,-
Townships
hereby certify the above statements are true, correct and complete.
Si nature of claimant
r+?ANON-
}:-VALUEt,,;,� =.-t;:
�ress (number and street, city, state, ZIP code)
3 e J Y, -2 -), +:1 44 Ga
/y t
a r
t ;ASSESSOR
•e,TRUE TAX _
- ASSESSED VALUE
- HOMESTEAD
RESIDENTIAL t t
USE ONLY _ s
U°`r:. wit �, r::W'�•t.":r^_ a.. '_,-
„'VALUE_
AT %a OF,TTV'
100
.. VA_LUE!s .'�d�
r+?ANON-
}:-VALUEt,,;,� =.-t;:
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
. r.:
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
P ':t� °+ i:�.?P ` -:`"r:.:...STANOARD.DEDUCTION ALLOWANCE._'i: :.'.. `a :n.' i-. as _r•�s -� �si:41;= -`.:.n
20 Pay 20
Lesser of 112 Homestead
Valuation or $6,000 S
L
Signature of Auditor Date signed
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