Homestead_CornwellCLAIM FOR HOMESTEAD PROPERTY TAX O R
r - _ ': CREDIT /STANDARD DEDUCTION
,, State Forth 5473 (R817 -07)
� Pd Prescribed by the Department of Local Government Fiance
AUG 1 3 2003
INSTRUCTIONS: See reverse side for filing instructions.
I (We) ` certify that oth
on the 1O d
s ay of March, AUDITOR 20_
1 (We) occu ed as our principal place of residence the following described real property for which a Homestead Property Tau Credit is hereby claimed:
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.
If buying on comracL Fee Simple owners name
Recorders office where contrail is recorded ( Record number Page
County Tonnship Taxing dislriq (city, town. lawn ipj
Parcel number Legal description D I Is the property in question:
�y /H p /O -/0 14•0 iR C. ❑ Real property ❑ Mobile Home (IC 6.4.1 -7)
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.
69& -001 - 58- 0/8 -pvo. /loo
.-
W1.11=1 1111i'l-0 111114
Land not exceeding 1 (one) acre immediately
" ;'�,; F'; ".. - -
surroundingresidentialimprovements.
_
Other land
(2)
y
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
- - _
Residential improvements or Annually
', --y r•�
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
..
Total improvements (line 4 through line 6)
(7)
Trial value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature ofPssessor
Date signed (month, day, year)
complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
_ pay 20 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser 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
Signature of Auditor Date signed (month, day, year)
STATE FORM 53 .IRn WO mREASURER PORM SIA
APPRIVW BY STATE aSARonr..f ottSTSSxN PRISCAIBtD BY 11W OEPARTMLYIOF LOCAL GOVERNMENT MANCE IC6-1.1-ra1
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 ma for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1 344-2080 requires taxpayers who receive the homestead standard 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 he accessed by authorized county officials.The nepannsent of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Cornwell, Jack R Etal
75 E \J�/
Ilazleton IN 47640 "w
199
Jack R Comwell Etal
C/O David Comwell
8312 N 75 E State Parcel Number Legal Description
Hazleton IN 47640-9231
Itltt'Itrrlr llrtt'tt'll ter ltlnttaltltl llltrrll tttllrrlrl ter 111 26-02-58-018-000.160-018 010-00160-OO PT MD 181-104.07 AC
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Ai/el h! eaeNc✓ t�lC
g Address(numbefand street,city;state and ZIP code - — —.g.X3ameas property address - — - — — -
Spouse First Middle Last
Mailing Address(Number and sweet,city,state,and ZIP code) Sane as property address
73/x— AJ 7 S£ pag-t ./ZN tin/ II 76 9 d
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
sloe
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 / Date