HomeMy WebLinkAboutHomestead_DawsonCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
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P�esaibe�f hy Ihe DeparVrianl of Laal Go�ernneM F'uwxs
INSTRUCTIONS: See raverse side /or filing instructions.
CERT4lCAT�1 STATEMQIT
n � FORM
� Hcto
�
YEAR
i(�"ie) � l i c t n! (1�_ �(�.c.�J�,)l.) � _ 8 "�rSP �al on the 1 st day oi Marcfi. 20
I(We) oopipied as aa prmapal place of : esidence the fcibwirg d� r�s:l property {or whiM a Hmw�GaQ-Prep�'��redt is haeby daimeA:
��(we) ownee ❑ nle buyirg unda cantrad ll C.l. 1
Have a henefidal in�re� in Me entity Mat is liade Tar Cie popeAy tazes m ihe property arW that avns.it�;fXOperty.Of�jg,buying u�er a oontracL
If buy'vg om m�lrarl. Fee SirtQle a�nela rema
Rem,dels o1Fce wh�+e mnhad is recaded
' ' — . . . . F , . �p..
CantY Tawral�P .
� �03$ ��
d1h p �� mmnbo tlre I�d na acceadin9 o�,e (1) ave
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- �/- crr� . U 3e�-
�r:DFD;, -- . - . - .
Rernd numbar Pege
tl . N • ' � . .'�. �, �., . . ,
' (fiy, tnwn. tow rp)
/1 , n �
/ (i</ I
/�� Is iha properry in Ouesfion:
�l I �� o�r � nwn�� rw� ��.c. 6,.,_n
a,�avws n� swcnre a �sea m Proa�,ce :,mme. a�� me use �d ��
�-, 'tASSESSORUSEONLY.:_'� r ; � �'TRUE�TAX ,;'. hSSESSED�VALUE .HOY�STEAD��� `NON-RESfDENT1AL..
. .. - .... .;�. , .. .,*}..,r: ,. VAG1E; � �. �ATi00XOF7TV � �.';.,.VALUE . �. . � x':;=,VALUE�.. - �.
_ c .(: s"
Land nOt escecding i(one) aae imrt�e6eda0ely '
surtound"mgresidentialimproNertienls. (�) ��, .. ..-._::'_....... � ;�.
Otlrerland �2� - -:; .
:{ `
TU� land (I'n�e 1 plus 5re � (3)
�e. }.�.-4£::'S� . �-
f ;,'.
Residential improvemenls or Mnualy Dweltirg (4) � a-��' 3 5 �:.:,, a
As�sessed MobBe / Mlaa�sed Home *.'; a:.,,
��Q �5� �'�� * - -
Otl�er unprovernenLS I (6)' i � �. ., � �{ c V � - ;': � �
—�-- -- — 1 - —�
T�al unprwements (!nre < (hrtxxrM1 Fne fi) --- {71 ---� ---' I ..'. ---
Tatel value (fure 3 pks Gne � I(g� I �
— ' —
I hereby �rtify th¢ above is true. mrtect. and s�&^�re ot acc�u Data s:p��ea
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�M�9 aaion - signema ot aldi1� Daw s:m�+f
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20 _ Pay 20 _
Lesser af 12 Hmnesi�d
van,ae«� «sss.000
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
tl�i£lORM!)Hlti /!'�MI
PA!`XWBFDBT ll�[
PFASIIAfR Po0.H SIA
fndiriJuals and ma;rinl coupks arc limitcd io orc homeueaJ �tandard Jedunioa As �he �ttcipi.of ihis deduction becomes
more beneficial, thrrc it morc ineentn�e Oun rcer (or homesteael &aud. Ilomn-rcaJ f2uJ caacs higher tac bills for all; therefwe.
HEA Uii-3009 requim mapaym who �ttri.�e ihe hwnenead standard dNuc�ion to .erilv thai �hey art elitiMe m mcei.e �M1e
benefi� an1 to prm�ide aAUitio�ul iJrntii�'inc informatwn nemsan� to allw' counre gm'rmmrnt to b:ercr muniror homesxad
filin�. This infomuiion x�ill 6e l.qw confi�lwial and rvn only he acresud Ay nminrizeJ counry o(ficials.'ITe Ikpannrent nf
Local Gm'rrtimem Fi�unm �� ill u.e this intorma�ion to crea:e Wols �ha� aill h:lp eqmtr offirials diminnt< hom<sicad ireud.
�� �r �
Taznarer N•ame Prnpem� Address
Dawson, Brian C
1031
Brian C Dawson
233 S Gibson St
PRINCETON IN 47670-2111
I�I��II���I�II��I���III�����I�I���II���II���II��II���II��I�I�I
?33 S Gibson
1'rince�on IN 47670
State Parcel Number Leeal Descriotion
�' 26-12-07-401-000.038-028 019-0003a-oo OLD Puw 4 PT
This form MUST be retumed to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
�• �
Ou�ner 1 First Aliddle Las�
Qr%ah Ch�;sfn /�e� �aw�ro,,
�_ Address (number nnd itteet, ciy, ste�c, and ZIP code) � Same as pmpem oddrtsi
.233 � � G.b.s on ��
Sxial Securiry Numbcr (last 5 diei�s) Ihivas Licrn.�e/SUte ID Nwnbtt Qast 5 digiu) Othcr (pleue spai[ in Part 4 below)
�—
spo� etm nram� t �,
Mailine Address (\umber and s1rtt4 ctiry'. SWIe, and "GlI' caie) � Same as pmpem addrts.i
Social Securiq� Number (Lsst 5 digits) Driver's LicenselS[ace ID Nwnber (latt 5 digits) Otha (plcase spccifv in Pan 4 below)
$0C
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Fach undersiened cznifies, under penalry of pepury•, that the abo��e and foregoing infortnation is true and correct and that he or she is elieible ro
recei��e the homestead standard deduction on this property. Each undersiened al>o undemands �hat, by claiming additional homestead deductions
unlau�fully, he or she may be liable for back taxec �d substantial financial penalties.
Oxan 1 Sicrosnae � Ua�e 1'el<phone
a -►a-�D ,� �
Spou;e Si�taiure ��� Telephwrc
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