Homestead_DaubyeE ^"�°„ CLAIM FOR HOMESTEADPROPERTYTAX
_��;: CREDIT/STANDARD DEDUCTION
�,` � State Form 5473 (R2 / 5�92)
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INSTRUCTIONS: See reverse side for filing instructions.
�1 ' - � ' . � __ ' (�ERTIFICATI
FORM
HC10
YEAR
m�m . . .. .. .
" certify.that on the 7 st day of March, 79_
�) o as our principal placA of residence t e following described real pdopbrty tor which a Homesiead Property Tau Credit is hereby daimed:
I(We) owned ❑ Are buyinq under contra . \J �• , �{ �g�q''
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pr�y� i�uyir��yrp�ntraci. ,
q 0.� eu7 �
CONTRACT RECORDED �
It buying on tontraa, Fee Simple owner's name
Recorder's office w�ere contraci is recortled '
"� PROPERTY DESCflI .
Counry � Township . � Tv�ing d. [rict ry. 1 n.. . m • �.
'P2�el e� Or /,� Legaldescription ,
� ,� �V
If any ponion of Ne residentlal structure or the land not exceedinq one (1) acre that immediatety surrountls that strucmre is used to produce income, describe the use and portion
of the pmperty milized ro produce income.
- PROPERTV OWNED BY CLAIMANT IN OTHER COUNTIES
Counry Township Counry Township
�eby��rtify the above si nts are true, correct and complete.
pJ � n l�.L.�a�/�
Atltlress numberalMstreef. ry,slate.LPCOtle)
ASSESSOR USE ONLY
Land not exceeding 7(one) acre immediately
surrounding resideniial improvemenis.
Oiher land
Total land (line 7 plus line Z�
Dwelling
Residential improvemenis -
Garage
Other improvements
Total improvemenis (line 4 through lina �
Total value (line 3 p�s line �
I hereby certify Ihe above is tme. correci, and
camplete.
v�nyi� action - Sgnature of Autlitor
19_Pay 79_
Lesser of V2 Homestead
Valuation or $2,000
Sgnaare ot
TRUETAX I ASSESSED
VALUE VALUE
(�l
(2)
(3)
141
(5)
(6)
I�I
18)
Signature ofASSessor
S
HOMESTEAD I NON-RESIDENTIAL
VALUE VALUE
Date signed
Date signed
Gibson County Auditor
101 N. Main Street
Princeton, IN 47670
� F'ILED
JUN S 2012
G'J. n�
GIBSON COUNTY AUDITOR
2748
5T.\�llUl4 a}YU�RU �lu�
.�PpRU'c,r� pl' QU E!W \POOf .•[( Q:Ri( J.N
�HLt('0.111GDIIt T4.IXJ'A0.l.Yk�tOF
° i�cuacaruxv a�n
Indi��iduaL. and rtnrricyf mupie. arc IimitN m oat honxs:eaJ >IamLud Jnluaiun. A� IF,e rtt<ip� o(:Ai> Jnluctiun 6ecoma
mom Mncficial. dwr. is rtrorc ir.irn�i�c �lun cccr lur hom,�¢yd Gawi. H�uncatcad (nud ca¢c� ��i;;M1cr taa bill� lor:ll: th�rcfor,
HF.:\ 1373-IIX14 re4uirs ta<pmen x5m n�;i�e [hr Irome.iraJ .unJ�rJ d<duciiun m.erity �Ea� dxy an eligiMe io recrirr �e
M-ncfii and io prmidc sldi�inul idcntifi�inE ir.lixmation nc;csvn� �o alk�x' cvmnr eo�cmmcm �u hrnR mmimr ho�rc��ad
filinp.'fhie informa�ion n�ill be A�yl contidnnial and can only br �ar..eJ by authorizeJ counn o0icule. The Depanmen of
Lacal Guvcrr.r.ncm Rnancc vill u.c ihi. informaiion io �r�tc mnl::hai will hcln counre ofRCLiI> climimm hamc>tmd (nud.
. � � . �
TaxpaverName LocationAddress
Dauby, Jesse J/ Holly S
Jesse J/ Holly S Dauby
209 E State ST
PrincetonlN 47670-1831
�I���'�II�I�111�1���1'I�'���II�I�I"I�II�I'I�"'I'11�11�11����1�1
209 E STATE ST
PRINCETON IN 47670
II II III�I�IIII���II�II�II��II�II I�III I�I�I�II�I�II lu II
State Parcel Number Leqal Description
26-12-07-203-OOO.SOS028 OLD Pvw 35 PT
This form MUST be returned to County Auditor's office. -� o
Please do NOT send this form back with your tax payment to the county freasurer.
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Add+es� (mrtnber and slrttL ciry�, sla:<. and ZIP cade)
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j�ody �
Addros (�ert�er md ssm, ciry•, staie, xnd IIP code)
S.
Numher (lut i digiis) Driv<ts LiccnsGS�arc (D Number Qu: 5 digis)
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Smc
IJ� 6Y
Samc az propem� add.ross
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spwifi• ir. Pan 4 bclow)
� Same as qvpem add;ess
Pan
undeniened cenifies, under penalry of perjury, that the abovz and foregoing infortnation is true and wrrect and that he or she is e(igible to
+c the homcsread standarcl dcduction on this propeny. Each undersienccl al>o understands lhat, by claimine additional homesttad dcductions
�fully, he or she may be liable for back uues and substantial financial penalties. .
1 Sig ` Uate � Telcphone
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