Homestead_Coplen�V�li� .
PrzSCriDea By S�ale Bw�O at Ia. Commissfoneis
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�
' � ' '.>?,; .' SEE BACK FOR FILING INSTRUCTIONS
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�°el ` ""` Y certify that on the tst day of
�..,.,ch, 19 I, (We) occupied a our principal place of residence the following described real property for
which' a Ho estead Froperty Tax Credit is hereby being claimed: //
I, (We) owned O O L o/'7 0 0 0
❑ are buying under contract
❑ have a beneficia� interest in the taxpayer
Properiy Description in Cou�nty � p Township
Taxing District (City, Town, Township): tl�tTg f'oSf1 �����ilI"�
Parcel Number or legal description shown on tax statement:
� ��,'�\� Q� s�� �4�� �4 �.� a—�_�__��_�..
If buyi�0� �fl��: [QW�lers name ��� simo�e ownerl
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l.ontract recorded in Recorders Ofiice - Record No. Paae_
If any por�Roi t�el�ential structure or the land, not exceeding one (7 ) acre that immediately surrounds ihat
structure is used to produce income, describe lhe use and portion oi the property utilized to produce income
Any olher counties in which individual owns or is buying real property:
I��reby certify the above.statement is true, correct.and complete.
�� G. ��,
. .. � . ' . . ' ' � . . Svce�
County Township
cnr. s:aie a�m
' Individual either owns or is buying under a contract that provides he is to pay the properiy taxes
on the residence, or has a beneticial interest in the taxpayer.
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� - FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding residenlial improvements
Other Land �
Total Land
Residential Improvements
Dwelling
Garage
Total
Other mprovements
Tota �r�vements - Line (6) plus (7) equals (8)
`.
I heie�y certify the above is true. correct. and compiele.
Signalure ol Assessor
(71
(2)
(3)
(4)
(5)
(6)
(%)
l$)
True Cash
Value
- ACTION BY AUDITOR -
App�OV2d: �/� �'v / ' � °!f `�"� ____
Assessed
Valuation
I�an
Homestead
Valuation
3�/��U �
Gibson County Audilor
101 N Main
PRINCETON IN 47670
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1RfASUAlAPo0.V:l1A
Individuals aud mr.ricrl couplec are limi�ed to nrc home9eaJ �tandaN Jed�n�ian. Ac the remipi of Uti� dcdunion b�comes
mere beneficiaL �herc is morc incenme tlun e�er for homesteael &aud I loma'tead $aud causn higher tac 6ills for all: ihertfae.
HEA I3ii-?009 «quirt5 iaip�yen who reccire the homes�cad slandard dnlucGon w veri(y �hat thep are elieiMe io rceei.e ihe
Denef.� anf to p�a'ide a�Wnfo�ul idemiirin� information �es-vey to allw' counp� gmemmmt ro bever moniror homesrcad
lili�a. This inlormation xill be Aryw confiemial and e�n nNy h aamuvl by amMr'vN munry officuis. The Depannrcnt a(
Local Gm'crmn<m Fiiu�rce �cill u.c Ihis miortna�ion m crcatt twis Ihat xill h:lp countt officials dfminatc homcshad Gaud.
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Tnxnarer Name Propertc Address
Coplen, Robert A
589
Robert A Coplen
R 1 Box 200
Princeton IN 47670-9202
�i�n��in����n�u����ni�i�nu�i���nni�i�i�i�i�u�i��in�
R I Box 200
Princcwn 1\ d7670�1��
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State Parcel Number LeEal Description
2Cr11-25-400-001.701-027 006-07707-00 PT SE SE 25 2 11 .87 AC
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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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Ow�ncr 1 First MidNe La9
RogERT � A�C�ni coPcE�J
g Address (numher end s¢eet, ciry, smtc, and ZIP codc) � Snme ns pmperty nddres;
�/5 8�n/ 350 5 �R /,LJ ��70�(/ iit/ �7670
$ocial $ecurin' Numbtt (last 5 dieits) Ihiver's Liccnxru�c ID Number (lai� 5 digits) Other (plcuc specify in Part 4 below)
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Spouu First Middle Ltct
BAR13R�,� ,�,�,� coQ � E/J
Mailim__� Address (Number and sVttt ciry', suie, nnd'LIP code) �$ame u p�openy addres
�f 5 3� 35a 5 �R i�J c���1 i.J c�����o
Social Stturiry Number (last 5 digia) Driver's Liccnsel5`arc ID Nmnber (lazt 5 digits) Othcr (plcue specify in Part < belox�)
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Each undersiened certifies, under penalty of perjury, that the above and foregoing information is trve and coirect and that he or she is elieible to
recei�•e ihe homestead slandard deduction on this propeny. Each undersiened al;o understands that, by claiming addilional homestead deductions
unlaa�fvlly, he or she may be liable for back taxes and substantial financial penalties.
ON'ner 1 Signct�ac Un4^ 7'elephme
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