Homestead_ColemanCLAIM FOR HOMESTEAD PROPERTYTAX
CREDIT/STANDARD DEDUCTION ^ `
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a��;�a ny ma oeaaro�„i or �omi c,��,�„�u F�
wsraucnoros: s� r��a� s;da �o� rdr�9 r�50-�rro�.
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FORM �R
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i !-J V Y��� /'Y '"' '-' "' y'— certify that ogviBslst d y.�March. 20_
place o( residence tlie folbwing desaibed real property for which a Homesteed Pfo 7 � s� med:
(we� ownea ❑ Eve tuymy ��aa o«,o-ea G�s c i (.�b r, i�� 'L9�G9i�'
lave a benefidal interest in Me entiry that is liade tor Ne property tarzes on the property and that ams the property w is Wying under a contracL
tt 6uy'v�g an aontracl Fee Si��le owrefs na+na
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Caimry
Tomsldp
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Recard num6er � Pege
Parcel nmmer Legal desai Ia Ne properry in quesUOn:
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N a P�n af Ihe imidaMial stniCUre a fhe lantl rwl i ne (1) aue ihaf immedately artwnds ihal s6ucWre ia used to produce'viwrre. dascriba Ne use end D�n
d JWUPeM utif�d b produce utmme.
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��'�.�. s�.��r�i��'!:�'�:r.�''���?��� :?�:rt�srauoium'oenucnori�ne�owa+ce,�;>*x�"��Il��'��i�?�;?�r����l��`-�?4`:u;°,� �
20_Pay20_
Lesser of 12 Homestead
Valuatim or E35,000 E
Sipnahce of Nditv _ Date signe0
Gibson Counly Auditor
101 N Main
PRINCETON IN 47670
541
MASURER f00.4 YI�
W�£L4MfTT iP:M'CF.IC 0.1.1-33l.I
Indiciduals anJ ma;rieJ touplo are Iwited to onc home�e�J �andaN ANu:tion. As the �eceip� ol �his deJunion beconu:
more beneficial. tMe i. more incen:ne dun acr (or homa'teazl framl. Ilomesead faud causes hi�her tm bilis tor all: therefae.
HEA 134-}-20W requ'ves uxEu.m xho recei.e the hanes�eaJ sundard deduction in verity tha� ehev me clieible m mcene the
benefi� and to p�a'ide addiGowl idrneiiyin� information �cnsan� �a aliw� counn� gmrmmrni ro bener monimr homesuaJ
filim2_ This iNOrma�inn will 6e Aep confidwial anA can only ta� accecuJ by authnrrzrd counp� o�Tcialx. lfie Ikpanmm�e o(
Lucal Gwcrtuncm Firtim�e will u.e thfs fnforma[iun m crca[e tuols ihat will h:lp eounrv ofiaial. dimi�um humestnA iraud.
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Tazpaver Name Propert�� Addretis
Coleman, Jeffrey D/Barbare A
Jeffrey D Coleman
813 S White Church Rd State Parcel tiumber
PRINCETON IN 47670-8100
���n��ni�i��n�u��������ii���n����ni���nni��u��n���i� 2611'15-101-002.�86-027
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P O l3or 5 W
Princetan M;7670 (��
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Lesal Description
006-0288G00 SANDY RIDGE SEC A 20
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.
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Owna 1 Pirst Middlc Last
_TEF�RE �. C o � e r-v� R�]
�c Address (number mid sveeL city, smtc, end ZIP code) Same as propeM addrev
13 S. l,�N=TE CNuRCN ��• PRZNCETaN I�1. �f`7�o70
Social Securi�}' Numbr� (last i diciu) Ihivas License/Sla¢ ID Number (lav 5 digiL) Other (plcue speciF in Pan 4 below)
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Middle Latt
BARBRRA AN N C D�EM AN
Mailinn Addrzss (Numbcr and Ntt4 ��)'. sule, and LIP cale) � Same az prayeny adJms
Social Stturiry� Number (lan 5 digia) Driver's Lice2ce/Sra�e ID Nmnber (lasi 5 digiu) Oiha (ple1ce speciN in Pan: belox�) .
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Fach undersi�ed certifies, under penalry of perjury, that the above and foregoing infortnation is true and wrrect and that he or she is elieible to
receive the homes�ead standard deduction on this propeny. Fach undersiened al;o understands that, by claiming additional homestead deductioos
unlaw•full}', he or she may be liable for back iaxes and substantial financial penalties.
Ow�ncr 1 Sieneum Dmc T<ICphonc
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