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Homestead_Cobb STATE FORM 11569(R2/13-09) TREASURER FORM TS-IAI APPROVED BS STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1.22-8.1 I LM1POt R■ AN at r!fl)0 ° 0 UU'WD) • R 0 P Y OWN • Individuals and married couples are limited to one homestead standard • c o As a r eeeipt of this deduction becomes more beneficial, there is more incentive than ever for h es uHo6 es�lead fraud 4.auses higher tax bills for all; therefore, HEA 1344-2099 requires taxpayers who receive thihomestead s • ndard deduction to verify that they are eligible to receive the benefit and to pilMlidJ adtl"rtional 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 officialsethe Dipartment of Local Government Finance will use this information to create tools that will El$�tt000c,$fwlBisoeliminate homestead fraud. . [FYlj1ag PRO P 121TV II FOR 1. T 0i Taxpayer Name Property Address State Parcel Number Lepel Description: Lisa R Cobb 1000 S Main 26-18-24-204-000.651-026 � 011-00651-00 BRENTON ADD 1 Fort Branch IN 47648 t/ Complete and return to: GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 1'ARTg3 Q 1j�INFORMATION �J�[J�j�/ - O«rer 1r' First / \ Middle �" '-J Last Mang Address(number and street,city,state and ZIP code) e as property address S sse First Middle Last Mai6rg Address(number and street sty,state and ZIP code) Same as property address Social Seauity Number(last 5 digits) Driver's License State ID Number(last 5 digits) save - Other(please specify in Part 4 below) • PAR 28 an01:911©0 GI • Each undersigned certifies,under penalty of penury,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 ( ) PART0¢ADDITIONAL INFORMATION . • �,2 CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT/STANDARD DEDUCTION � State Fwm 5473 (R6 / 403) Prescribed by the Departmenl d Local Govemment Finance INSTRUCTIONS: See reversc side !or /iling lnsVUC(ions. FORM HC10 �'�'�. 1 YEAR , f _ _.J :_�/ ��e) �� \� certiry thaf on the tst day of March, 20 1(We) occupied as our principal place of residence Ihe following described real properly for which a Homestead Pro�perty,Tac.Credit is 1 e eby daimed:� 'O GBSpN Cf^�✓v � �� ❑ I(We) owned ❑ fve buying under contract J`I __;�. , Have a beneficial interesl in the entily that is liable tor the property taxes on ihe property and Nat owns the property or is buying under a conVaG. If huy'u�g om m�uaq, Fee Simple owners name Recordefs afice where conVacl is remrAed �.-�i:��".c.i�f{t°?��4��",t�4i �:�3 Counry Tamship ri-� � � � w IRemrd number I Page ION�`�r �-:r,s;�i.t ?r #��u a' �.;�R'`2.�.��--�� ritt (nry, fown, fownship) Is Ihe property in qu n: �roperty ❑ Mobile Homo (I.C. 67.7-1 N any portion ol Ne residenlial sW cture ar the iand na exceeding ane (t ) aae Nat immediatey wrtounds Ihat swGUre is usetl to protluce income, describe the uu and portion ot Ihe propury uUlized to produce income. �' a�'ri�''��`�i> �� '.��,`�?'.'..,��,*'STANDARDAEDUCTION`ALLOWANCEtx', 4iu'�t'�.�a.#-.°'.��"f- •. ��``..`�?' .0 .! r� t�."i`.cdx�ZSiTC _ Gi.'.`�.'-1GV'�.fi��E.-s. snca' 20 _ Pay 20 _ Lesserof 1/2 Homestead 5 VeivaLOn a 535.000 Sgnatureoffwddw Dat �gne �� _0