Homestead_Cooper etMEE row!Mt.'IC Nor TRrASJ4Or 10KM 73-IA
ARYMP:ED BY flat BOARD WM Tt:TS.-on EaUYRIBED BY till DEPARENEYTOF LOCAL GOVERNMENT FD:ASY'E K- I.I-L'-1.I
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N Main
PRINCETON IN 47670 IndividuaLs and married couples are limited to one homestead standard deduction.As the receipt of this dedllnion becomes
i more beneficial.there is more incentive than tier for homestead fraud.Homestead fraud causes higher tat bills for all:therefor
HEA 1344--2009 requires taxpayers who receive the homestead standard d deduction to verify that they are eligible to meeise the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filint..This information will be kept confidential and can only be accessed by authorized county officials-The Depannlent 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
Cooper, Robert C/Leann S
RI 13os 181 ,r,{...__;
•
Fort Branch IN 476
2996
Robert C/Leann S Cooper
R1 Box 181 State Parcel Number Legal Description
Fort Branch IN 47648-8002
26-19-19-203-001.233-02 /INDIAN HILLS 23 PT NE 19 3 10.33 AC
Illitilitelillotiolltilliolillisill tau IIIIIIIIIImilitil
0-27
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 First Middle Last
o be-c---E- C Co par
el Address(number and street,city,state,and ZIP code) U Santo as property address
/.SO lU 7a'd S �-4 8,,,,,,,6,.•
,,,i3r, --A ci76cIt
Spouse First Middle /�' Last
0 r,-) S C oo p f-c
Mailing Address(Number and street,city,sate,and ZIP code) 0 Same as property address
/So g 78'0 S 11 131'a het W. 4176/7Y
'
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 Si ^to�re il Date
to
�.�•n
��'' °a CLAIM FOR HOMESTEAD PROPERTY TAX
���'� CREDITISTANDARD DEDUCTION
.�.;;� State Form Sa73 (R2 / 5-92)
�u•
INSTRUCTIONS: See reverse side /or liling ins(ructions.
FORM
q �' h /i r ) 4 `.
YEAR
� - GERTIFlGATION STATEMENT- � � � •
��We) _ �� • certify thai on the 1st day-o( March, 19�
ie} occupied as our principal place of resfdence the following described re property for which a Homestead Pioperty Tax'Credii is hereby Gaimed
❑ 1(We) owned ❑ Are buying under contract , .
❑ Have a beneficial interesi in ihe entity thai is liable for the property taxes on the property and that owns the property or is buying under a contraci.
� � _ CONTRACTRECORDED� _ � . .
IIf buying on contract, Fee Simple owner's name ,
ReCOrder's office where wn(rac� is recorded Retord number Page
County
Partel number
It any-O-���
ot Ne pmperty uti
/'X� —
PROPERTY DESCRI
Tazing
Legal description
�3ab -c� �; ��,�;,r, l��
itlential stmcwre or ihe Wnd noi exceeding one (7) acre that immediatey surrountls that
�o pfodute income.
� �Y / l. -1 �
fAvnship)
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
p Caunry
��eby certify ihe above statements are ime, wrrect and complete.
Address (num6erarMStreet, ciry, slate, ZlPwde)
produce fncome. describe the use antl portion
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL.
VALUE VALUE VACUE VAWE
Land not exceeding 1(one) acre immediately ,
surrounding residential improvemenis. (�)
Otherland (p)
Total land (line 1 plus line 2� (3)
Dwelling � (a)
Residential improvements -
Garage (5�
Other improvemenis (6)
Total improvemenis (line 4 Ihrough line � �7� I
Total value (line 3 pLs line 7� (g) I
I hereby certify ihe abOVe is irue, torreCt. and Signature ot Asseswr Da;e signed
complete.
ifg action - Sgnawre of Auditor Dare signetl
�
19_Pay79_
Lesser of 7/2 Homestead
Valuation or 52.000
STANDARD DEDUCTION
E
Date sig