Homestead_Dossett (3)a� '4 CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
/ State Form 5473 (R2 / 5 -92)
INSTRUCTIONS: See reverse side for riling instructions.
l lu . V-- /S ji 9zl 9 AmA
occupied as our principal place of residence the following described real property for which a
MAY 0 2 1997
Tax Credit is hereby claimed:
L� I (We) owned L1 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
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
PROPERTY DESCRI ON - -
Cou y
Township
-
Taxing istrict (ra
topi wnship)
Parcel number
Legal descripti
-
'
l -
(2)
(:g\ -��- 10
II any portion of the residential structure or the land not exceeding one (11 acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
Total land (line I plus line 2)
(3)
XV
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
#eby certify the above statements are true, correct and complete.
Sign ure o clpim ,
ress ' um er and srre try. state. ZIP wde)
6 o Z
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding I (one) acre immediately
surrounding residential improvements.
(1)
Signature of Auditor
Date signed
-
'
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
tying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE '
19 _Pay 19
Lesser of 12 Homestead
Valuation or S2,000
S
Signature of Auditor
Date signed
StVE FORM!!!NI SAM) TUANIIE FOI;w3tA
.VpRP'FD BY[ATE WARD OF AIWA i,TS.ran RLAWBm DS nW DEPMIMMEYT OF UxSt rsnERNNIAT FINANCE ICNJ -ii
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
•
PRINCETON IN 47670 Individuals and married couples are limited to one homestead sundanJ deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than net for homestead fraud homestead fraud causes higher tar bills for all:therefore.
HEA 1344--2609 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kept confidential and can only be accessed by authorized county officials.The Ikpanntent of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead Baud.
PART 1: PROPERTY LNFORMATION
Taxpayer Name Properly Address
Dossett, Michael W
P0 Box 52
Patoka IN 47666
997
Michael W Dossett
P O Box 52 State Parcel Number Legal Description
PatokeIN 47666-0052
Irlrr'Irlrlrllrrrii ll rri lit r i,rrrr1r1 rrF Ir Ir�r�Frr iris II 26-05-58-026-001.094-018 010-01094-00 MD 261104.85 AC
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
- P1lehad WR / Nt D0.sset /--
. -- g Addrvsi(numbs and a m Y,city,state,and ZIP code) — —--__ _ — - -1 1 1-S a m e _ -- • —• •-_ — __
488 N 75E Po, 13c)450 P4}1 oiCa._ // _ ' N /4 1 C 6 6
Spouse First Middle Last
Mailing Address(Number and stree4 city,state,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
Sur
PART 3:CERTIFICATION
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 Si tune A Date
)
PART 4: ADDITIONAL INFORMATION