Homestead_Dossett Sinn FORM!)X Iri 5.01 flFASURLZ FORMIIA
APPMWED BY CIelt an&RDnF NO-(L-ars.ym PILISIMIED BY TIE DEPARTMENT OF LOCAL FAVCRNMLhi FINANCE It'41.1-L'-r.l
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N Main IN 47670 Indisiduab and married couples are limited to ore homestead standard deduction.As the receipt of this deduction becomes
\ more beneficial,there is more incentive than nee for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
�• HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they arc eligible to rxceise the
benefit and to provide additional identifying information nemsan'to allow county government to better monitor homestead
filing-This information will be kept confidential and can only he accessed by authorized county officials.The Ikpanment of
Local Government finance will use this information to create tools that will help cotmt'officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Dossett, Kenneth/Judith
P 0 Box 142
Patoka fN 47606
5 Q\
Kenneth/Judith Dossett
P O Box 142 State Parcel Number Legal Description
Patoka IN 47666-0142
111111111111111111111111 l l l l 1121111111.11111111111111111
26-04-14-400-000.659-018 010-00659-00 PT SE p 4-1-11 5.50 AC
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.
.PART 2:TAXPAYER INFOR%IATIO!V
Owner I First Middle - Last
� � N � N � k1 y Doss 1
ng Address(number and street,city,state,and ZIP code) In Same as property address
Po box 42- pA V iM C) (7
Spouse First st
A / Middle La Doss
Mailing Address(N ber and street,city,$ate,and ZIP code) �� Same as property address
c6 fax i (1 , B 1\Ta a L i 147 le (e 16
Each undersigned certifies,under penalty of perjury.that the above and foregoing information is true and correct and that he or she is eligible to
receive the homestead standard deduction on this property.Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Sig arc Date
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 F2/5-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
10
APR 16 1998
CFRTIFICATION STAT MENT -
L(We) h �) .oe , 19
occupied as our principal lace of res nce the to o in described real property for which I�� -nc
') P P P P 9 P P Y egtEP.2 riy`tak Credlt i5 ee b claimed:
v I (We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
_ CONTRACT RECORDED _
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
(ll&�Al
TRUE TAX
VALUE
PROPERTY DES RIPTION
County -
Township
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Township
Tax g dis (p town, to)
Gounty
Township
eby certify the above statements are true, correct and complete.
(2)
Z
Parcel number
Legal de
on
ZIP
(vide)
It any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
Residential improvements
Dwelling
7,6
(ll&�Al
I
ASSESSOR USE ONLY _
TRUE TAX
VALUE
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Township
Valuation or $2,000
Gounty
Township
eby certify the above statements are true, correct and complete.
(2)
S cure of claimant
A
(FbergQd
Vyl1�J
Street, aty, state,
Q
ZIP
(vide)
I
ASSESSOR USE ONLY _
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
`
Otherland
(2)
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
-
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19
i
Lesser of V2 Homestead
S
Valuation or $2,000
Signature of Auditor
Dare signed