HomeMy WebLinkAboutHomestead_Dishon (5)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
` d Sate Form 5473 (RB / 7-07)
Prescnbetl by Uro Departmen( ot Local Govemment Finance
INSTRUCTIONS: See reverse side /or fi/ing insWctions.
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JUN 1 1 2009
� M'e) � � certify that o((tiieis�day o%ia�cn, zo
1(We) occupied as r'ndpal place of residence the fdbwing described real properry for which a Homestead �j.lT�QldltlRYs A�F6b°y�daimed:
1� I(We) owned ❑ Are buying under contrad
J Have a beneficial inlerest in the entity that is liable fw Me property fa�ces on the property and ihat owns the property or is buying under a contrad.
If buyin9 on wnUa0. Fee Simple ownets rmme
recqded
County
Parcel number
If arry portion of Ure residenfial sUuclure a Ihe land nd exceedirg orre (1) acre
of Ihe propBrry utiOZed b P�duce inmme.
o�o - /�-0 � o?Q/-Od/. o3a/�'-QaZJ�
ouanry
Twvnship
I hC2� GEfIf�' alB 8bOV0 5�21ER1Bf1C5 dR W2, CARCC( 8fld COffIP18fB.
arH stre�al�dty, atate, en0 LP�pde)
(cify, town,
Is Ihe
wrtounds thal
Record numbar
Page
i queslion:
Reai property ❑ Mobile Fbme (IC 67.1-n
�ra is used In produce'u�mme, deuriDe the use and ponion
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land not exceedirg 1(orre) aae immediatety :y y�,,,T� i� �'�s �'''r'�''t 5� ':_ `
surtoundirg res'dential improvemenis. (�� t:�:,..<_<.v'�:,°>�'-�_..� ..,; ,.'� :.- -
Other land -' �: '� = - -
�2) _ 't=:.:
Tdal land (1'me 1 plus 1'me 2) �g)
Dw¢Qing (4) -� �i.�p-�f �`,a`/} �* ;~ . o \ „�.i
Residential improvements w Mnually =`c�� '` ��n;�' � Y:_: ` xi .:�
A55e55ed Mobile / ManuFaCNred HOme _ ..,Y "� ���` r f : _ �.
Garage �5� a a�t.� : a- ,� _
i..�
Otherimprovements (8) - - .�,.:_.
Tdal improvements (!'me 4 thrt�ugh line 6) �7�
TUaI value (line 3 ptrs li/re n �g�
I hBfeby CeNfy Ule abOVe is We. WrtECt, end SignaWre af Assessor Date signeC (month. daY. Y��
camplete.
Vaiy'ug acfion - SigruWre of Autlitor Date sipned (rtxnN, tlay, yea�
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20 pay 20 _ qs,ppp tor 2007 pay 2008 42,000 for 207 0 pay 2017
Lesser o( 12 qq 000 for 2008 pay 2009 47,000 for 2011 pay 2012
Homestead ValuaGOn 5
« 43,000 for 2009 pay 2010 40.000 payable after 2012 �
Signeture oiFwditw Data signed (mmN, daY•Y��
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
F�[?
fUR i00.M a� W IR_/)'.NI
iRtASUIlE0.Po0.M:}IA ' ,
hWividual> aud ina:ried rouples are Iimi�eA m nrc homc.tcaJ �tandaN Jeduaion. As �he �eceipt ol �his dNunan bttoma
more beneficfal, thrre is morc incentnx chan r�er (or homestesl &auJ. Ilome��ead faud nuses hi�her ta� 6ills tor all: thercfwe.
HEA 134-i-?IX!9 require� taxpacen xho recci.�c ihc Iwmes�cad sundarJ �viunion �o veri(v tlut they art eligiMc �o rtcei.e tAe
benefit aN to p�a'ide addi�iowl iJentityinc intormatwn necr.-vry ro allw' counn� ememment ro Ne¢r monimr homattsf
filir��s. This intarmaiion xill be Aapt crnOdemial anA can nnly M: armaYf b�� amlar"vivi cowy� offmials. The IXpanmmt o(
I.ocal Gm'ermmrnt Fi�um�e xill u e �his in(armation tu cr<am u�ls �lui �ri0 h:Ip cvmrtv offiriaL+ c6minnte Iromestead fiauJ.
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Taxpaver Name Prooert�� Address
Dishon, Perry K C'f7� S'.�
3/G �nr
�-;c-c�ssov
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Perry K Dishon
316 E Pine Sl
PRINCETON IN 47670-1624
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State Parcel Number Lesal Descriotion
j( 26-12-07-201-001.209-028 01�012os-oo OLD P�nN 140 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.
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Ouner 1 First M1fiddl< Lat�
P��' 1� e�-f ��s�
e Address (numbcr m�d i tirv, smtc, and ZIP code) �Seme ns pmpem add+ev
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Socel Security Number (last 5 dieils) Ihivds Liceme/Statt ID Number (la.� 5 digits) O�hcr (plcue specify in Part 4 below)
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Spouu First A1iddlc Ltit
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Mailin_ Address (Numbcr and sVttl city, sm�e, and "LIP wik) � S'smc •ss pmpem add�ess
Social Sccurity Numbtt (lut 5 digits) DrivcYs LicensNSUtc !D Nianber (Iast 5 digiu) Other (plcssc spccif� in Pazt 4 below)
Sva
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Fach undersitmed certifies, under penalry of perjury�, that the abo��e and foreEoing infortnation is we and correct and that he or she is elieible to
receive the homestead standard deduc�ion on this propeny. Fach undersiened al>o understands that, by claiming additional homes[ead deductions
unlau�fully, he or she may be liable for back taxes and substanrial financial penalties.
Ow'o r 1 igne0ue 6ete 7'elephonc
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SpouseSip�aeure g�e Telephonc
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