Homestead_Coomer (6);� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� � Sta�t Form 5473 (R6I403)
Prescnbed by the DeOanment d Local Govemment Finance
INSTRUCTIONS: See reversc side loi /ilin�� inslrur,li��ns.
�d''c � :-=x- .'1;,--.- • . .:�--,:.�. _ - CERTIFICATI
FORM � YEAR
.v3._ - .. � �in�cm�ni _. .- - .. . .
��e) • � certify thal on t pv 2p
I(VJe) occupied as our principal place of residence the following des b d real property tor which a Homestead Pr��;���h�dai�ed:
V 7 AUOITD
❑ I(VJe) owned ❑ Are buying under wntract
� Have a benefidal interest in lhe eniiry that is 1ia61e for the properry tazes on 1he property and that owns the property or is buying under a conVact.
If 6uyinq om m�traa, Fee Simple ownefs name
Remrdefs ofice where contrad is recorded
Counry
Parcel
Tw'nship
If any ponion of ine residential struc�re w the WnE t exceeCing ooe ( acre
o( the properry utilized m produce inwme.
County
To.vnship
I hereby certi(y the above statemenls are true. correct and complete.
)RDED . � " _ . - � '�i�i <;'.�' - -. . . .
Rewrtl numDer Paqe
tIBTIONrt-� � ° . :. . - - _= - =-
I ritt ( y, fo�" townshi ) _ �
Q�/'2 u�� _ .
15 Ne prOperty i question:
Real properry ❑ Atobile Hamo (/.C. 67.7-7�
sunounds �hat qure is used lo produce income. desaibe ihe use and Dortion
BY CLAIMANTiN
County
Tavnship
�
�� �� �'�` ' ASSESSOR-0SE ONLY . . TRUE TAX ASSESSED VALUE '� HOMESTEAD NON-RESIDENTIAC;
$.,r.ee1. s � : _ 2_...a;�- . . � �� ' VALUE AT100°/aOETTV- VALUE -•.•`VALUE:
Land not exceeding 1(one) acre immediately �- +��<=+�_•-=°"`�-�� -.
surrounding residential improvements (� � . .�- , I
Otherland (2)
Tcfal land (line 7 plus line 2) (3)
Dwelling (4) - - - _
Residentiel improvemenis orMnually � .. � .�`, y* , ,-'`.
Kssessed Mobila / Manufachued Home Garege (5) ,
Other improvements (6)
Taal improvements (line 4(hrough line 6) (7) I I
Total vaiue (line 3 plis line n (g)
I hereby certify the above is we, wnect, and Signamre or qsseswr Date syned
complete.
Venlying action - Signature of Anditar Date signed
'�'? � �� .r :' � � - •STANDARDDEOUCTIONALLOWANGE � - - -� -
20_Pay20_
Le>ser o� 1/2 Homes:ead
va�uauon or 535.000
S
SgnaWreo(AUditw ' IDatesignetl
SiiRiOA]I�!N10.:(YNI 1RFASU[FRHIR4i}IA
.���Mw'fDBY�1niEEtIVtDM!F«� i[.vrl pAF3A1Bm0Yi�1lDElARMEY�OFWALfU\�LW(]�iiQ:n.�CEICVI.l-2:-l1
Gibso� County Audilor
101 N Main � � � ' � � � � ' ' � ' ' � '
PRINCETON IN 47670 IndividuaL anJ mrriN couple� are IimiteJ to orc homeuead �tnndaN JNunion. As ihe rtttip� oi �his dnluction bcconrcs
more beneficial, thn< is morc incentn'e tlun r�<r (er M1omesteacl &aud Ilomnxad Baud causes hi�her tn bills (or all; ihe�efore.
HE.1 13id-�0(!9 nquim U�paren who recci.e �hc hanes�caJ standard dNuction to .eril'y ihat the�' are eligiMe to rtYei•e ih.
benefi� anl ro p�a'ide a�Wilfunal idrntilrim_� in(urmarun rcarssarv ro allw� aounry grn�emmenl to Nemr mmiror Iwmes�ead
\ filin��_ This in(nrtna�inn x�ill M Ae�w conf:deniial and een nnly fK: acce.uJ by auihoeiied roumc o(ficiai..'fhe Ikpanment of
\ �AK.I� GOKlMICflt FINMC U'JI u+c this iniortnation w areaee twls that will hcln caunev ofTirialc diminnm Mnn�a.aJ fra�d
1351
David Carl Coomer Jr Jr.
R2 Box 168 B
PrincetonlN 47670
Taspaver Name Prapert�� Address
Coomer, David Carl Jr/Jaclyn N
R2 E3ox I fi {,( �
Princeron f\ J7670 � u/n
h � F��i
a� �`'�
State Parcel Number Lesal Descriotion
2E12-16-400-004.024-027 Oos-oa024-00 HEIGHTS CHAPEL
ESTATES LOT 1I2PT (2.091 AC)
. . _ _ _ / (2.677 AC) D-10 D-10 _ _ _ _ __ _ _'
1�
This form MUST be refurned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
Addrzss (numbcr and strect, city,
�g � �J� �J • Cf1.fJ(
Seeurih' Num&r (Iast 5 di¢its) Ihivtrs Littnse/Sute ID
li� Address (/:umber and stree4 ciq', stale, and "LIP cak)
a�-8 �. f50 S .
al5tturity NumbF� (luc 5 dieits) Drivds LicensdSu�c ID
.–. �.–,
or
digiL) � Other
�
Snme ns propem addnv
in Part 4 below)
Same:v} p`opem addrts:
(last 5 dieia) � Ocher (plcsc spccify in Part 4 bclow�)
penalty of pequq•, that the above and foregoing information is we and correct and that he or she is elieible to
�ction o his property. Fach undersigned al>o underslands that, by claiming addilional homestead deductions
for back �tax and substantial financial penalties.
[htc Tcicphone
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