Homestead_Dorris�,. R.,,
e; °, CLAIM FOR HOMESTEAD PROPERTY TAX
x��� CREDIT/STANDARD DEDUCTION
,�,` � State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See ieverse side for filing instructions.
STATEMENT�
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1(We) �� �� ��� %vi cenify ihat on ihe 7st day of March, 19� �'v�
��e occupied as our principai place r sidence the following described real operty for which a Homestead Property Tau Credit ishereby claimed:
We) owned ❑ Are buying under contract . �
❑ Have a beneficial interest in the entity that is liable for ihe property taxes on the property and that owns the property or is buying under a contracL.
� �� � . CONTRACT RECORDED = � � ' � �
If buying on coniract, Fee Simple owner's name � - ' �
Recortler's ottice where contract is recorded Record number Page
Caunry
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Legaldescription
PROPERTY DESCRIPTION
If any portion ot the resitlenfial slrucNre or the land not eaceetlinq one (7) acre Nat immediatety wrroL�ds ihat strucNre is used to produce inmme, descdbe Ne use and portion
of Ne pmperty utilizetl ro protluce income. _ .
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� ASSESSOR USE ONLY : TRUE TAR ASSESSED HOMESTEAD NON-RESIDENTIAL �
VAWE� VALUE VALUE _ VALUE ,
Land not exceeding 7(one) acre immediately
surmunding residential impmvements. (�) '
Otherland (z)
Total land (line 1 plus line 2� (3)
Dwelling (4) .� � �
Residential improvemenis
Garage (5) � '
Other impmvements (6)
Total improvements (line 4 thiough line � (7)
Total value (line 3 p�s line � (g)
I hereby certify ihe abOVe is irue. COrrect, and Signature of Assessor Date signetl '
complete.
Ventyirg action - Signature of Auditor � Date signed
19_Pay79_
Lesser of 1/2 Homestead
Valuation or 52,000
DEDUCTION ALIOWANCE
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signed
Gibson County Auditor
101 N Main
PRINCETON IN 47670
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ITAR W0.M!)W 12'/fWl
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IndividuaL. anJ ma;riN coupl� are Iimi�ni io onc home�ead �andaN JNuction. As ihr �ttrip� oi �his dcducti�n hconxa
mure beneficial. there i. more incrnm�e than e�er fur homes�eazl fraud Ilomn'teml f(awl causes higher b� bills for all: thercfore.
HEA U3;-2IXW requim uzpa�en r.ho receive ihe haneneaJ smndarJ JeJuclion m verify �MI they am clieiMe �o meei�e IM1c
benefii aM to p�a'idr addilion�l idemiirinc in(wmation �xxYSS�n� to allow counn� gm�rmment tu betmr moni�or hameseal
filing�. This information xill be Aep confldemial anA can nNy h: aceessed by authorizrd rnunty ofT¢ivi�.'fhe Ikpanment o(
Lacal Gwcmmcnt Fina�rce �cill ua �his infortnation tu cream twls Ihat x'ill h:lp cvwm' officials eliminme homet�cad &aud.
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Tasparer Name Propert�� Addreas
Dorris, Gary W Sr / Faye E
Gary W Sr / Faye E Dorris Sr.
602 W Walnut
PrincetonlN 47670-1256
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60? W R'alnm
14inccton IN 476�0
S[ate Parcel Number Leeal Description
k 26-12-07-101-003.125028 01s-o3725-0o ESTES ADD 17 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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Ow�ner I First Middlc LaSt
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g Address (number end sveet, cirv, s�ate, and ZIP code) nmc as property addms
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$ocial $ccurit}' Number flase 5 diei�s) Drivers License/SUm ID Number (last 5 digiL) O�hcr (pieue sptci( in Part 4 below)
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Spou,e First Middle Lut
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Mailing Addmss (Number and strect ��}', s�a�e, and LIP caie) I� Same u pmperty addre5.i
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Social SecuriR�
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Each undersiened certifies, under penalty of perjuiy, ihat the aboce and furegoing infortnxtion is trve and correct and that he or she is elieible to
receive the homestead stan deduction on this property. Fach undersiened al;o undersiands that, by claiming additional homestead deductions
unlawfully, he or she ma iable for back taxes and substantial financial penalties.
Ownn I Si�mavue D2te Telephone
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