Homestead_Dawson SIAM FORM flat.10./}-N1 mrASUIEA roI01 YIA
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Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead atandani deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than net for homestead fmwL Ilomestead fraud causes higher laa bills for all:therefore.
HEA 1344-2009 requites taxpayers who receive the homestead standard deduction to verify that they arc eligible to recene the
benefit and to provide additional identifym= information necessary to allow county government to better monitor homestead
flints.This information will he kept confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Dawson, Bradley NI-leather
4397 S 550 E
Princeton EN 47670
4189
Bradley A Dawson
4397 S 550E State Parcel Number Lesal Description
PRINCETON IN 47670-8768
II'ill'lll'1IInI,IIIIIuI111111 IIuIItIIuu111111IInuIIIiII1 26-12-36-400-001.523-004 D101523-OOESE 36-2-101.00 AC
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
,BI:ADLEy A D4tt-so„,_
IDAddress(number Bed street,city,sate,and ZIP code)- — — _ -- -- — -- --�%Snrne as property Bdaress - . --' -.—
1/39 .3 S sso E• /0 ATNGEToN sit- y-16-10
Spouse First Middle Last
R CAM/cK A /701.a<jd i
Mailinc Address(Number and street,city,state,and ZIP code) {'Stole as property address
•
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 Signature Date
III
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form, 5473 IRS 14-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling
HIM
pA 1 �.
i I
I (We) certify that on-T66-W&l arch, 20
1 (We) occupied as our princip I lace of residence the following described real property for which a Homestea0VMqM&Q"'AbS"Paimed:
❑ I (We) owned ❑ Are buying under contract
IHave 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.
IAV_Irl'�;t'�r _ ., � 'XK74t� ONTRACT!RECORDEDQ�',
a945W24 - XL
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
1_PR'0P_ERT.'Y__6ESCRlPT1ON iV'
Coun
Township
'aon
T
Twun trict ( ty, to". township)
'Y"
County Township
1 hereby certify the above statements are true, correct and complete.
�mc"
Parcel number
at description Is the property Question:
2_10 119C property
-
0
ZA6 property ❑ Mobile Home (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediatety wmounds that ructure is used to produce income, describe the use and portion
of the property utilized to produce income.
OKOPEkWOWISIEC'BY CLAIMANT ikbTHEk*'66((Nflifgilk-,�," &4 i',-4@ M
County
Township
County Township
1 hereby certify the above statements are true, correct and complete.
Signs ure of claimant
A
1dress (number and street, city, state. ZIP code)
q g
-
0
K,
USE ONLY ',',;-_
Z ,is TRUE :TAX
A
ASSESSED VALUE
,';'�;'tASSESSOR,
100%'OF,TTV-;
C'V1ZVALUE';--1 . P
4
Land not exceeding I (one) acre immediately
Valuauon or 535.000
Signature of Auditor
surrounding residential improvements.
Date signed
4W,
Other land
(2)
V- J,
Total land (line I plus line 2)
(3)
Dwelling
(4)
VtW"r,4
lResidentialimprovementsorAnnually
.!:V*k - Wit',
Assessed Mobile /Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARDMEDUCTION
20 — Pay 20 —
Lesser of 112 Homestead
S
Valuauon or 535.000
Signature of Auditor
Date signed