HomeMy WebLinkAboutHomestead_Davis (9)iOflM HC 70 7979 To & FiIM in Mpliwte
ReuriEeO By State Board ot Tax Commiuioners
CLAIM FOR HOMESTEAD PflOPEflTY TAX CREDIT FOR YEAfl 19�`L `/
SEE BACK FOR FILING INSTRUCTIONS ��9_ posys-oa
�(We) �~1����-�"�- a-(/-�^ -°L �'a,�-�� certify that on the 1st day of
March, 19��, I, (We) occup�r principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) �owned
❑ are buying under contract
❑ have a beneficial i terest in the taxpayer
Property Description in �� County ��--� Township
Taxing District (City, Tcwa-�ewrtship):
Parcel Number
If buying Ofl contract: Owners name ��� s�mo�e owner)
or legal description shown on tax statement:
i�
Contract recorded in Recorders Office - Record No
If 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
Any other counties in which indi�idual owns or is buying real property:
�hereby certify the above
�-, _ _ ,-�
nt is true, correct and complete.
County Township
Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Lantl not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land � ft
Total Land �J
U
Residential Improvements
Other Improvements
,,__ ' .
t *
True Cash
Vaiue
(�) �Z/o�
- (2) "
��� 3 <2/Oo
Dwe�ng ��`� /�a
Gara9e379 (s� d1SS�. o
Total �6� ���
// ���� —
�� �.-
Improvements - Line (6) plus (7) equals (8) �-(8) /_;'�c�
by certify ihe above is true. correct. and comple�ten'r�p
ol Assessar_'� �
- ACTION BY AUDITOR -
Assessed
Valuation
7 00
/ r
jj�j��j�j
j���'�ji%
/,°,//,%%;�/�%r
Homestead
Valuation
700
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--�i j�j�/�jjjj
.
�. - �
Gibson County Auditor
101 N Main
PRINCETON IN 47670
�\
1673
Sl\iE IORM!)Y+�IC/ w�l
A�V W I�'En Nl' ci.11f Mi1lOM VYYM'.\it. `Vu
TNFASUAE0.fORNS1.�
fi0\eLVH[TifPA\CEICVI.1- J.I
InJieiJual> anJ rturriN coupka are I�ni�ed to orc homcueaJ >tanAaN JeAu.�ion. Ay �he receip� ol �his deduaion becomes
murc brneficial, ihere is marc mcen:ne than ecer (or homnieyl (nud. Ilomdm;rl fiawl cau:.� hicM1er tac 6ills (or all: therefar.
HEA I;�-i-]Ol!9 rcquim uapa.ers r.ho receire ihc hanaicaJ >iandard JeJuaion �u vcrify thu� �hey arc'elieiNc m mcei.e iF.
brnefit aa1 ro p�m'id<:xY]itiurul identiiyine iniumiatwn �wcnvrr �o alluw ewnn� �nrmmeni eo Nemr moniror IwmecreaJ
filirpy. Thic inlomuiinn xill 6e l.�v cmlidemial anA ran nNy M• acor:.cA Fy awM�ird mnnp� n17'Kial+- The Ikryunmrni nf
I.ceal Gm�crmn<m Pivirce will u.c thfs fn(ormaeion m arcae uYAa that will hcln nxmrv ulficiak dimiwc Mrmcamui fiauJ_
Clafide A Jr / Nelle Davis Trust
�69 S Broadview Circle DR
�P.rinceton IN 47670-9413
�i�u��u�����u�u����iTi�i�n��u�in��n�����in�i�n��iu�
Tasoaver Nemr
Davis, Claude A Jr/ Nelle Trust
State Parcel Number
�( 26-11-12301-000.545-028
Prnpem� Address
aa t�r ; i s
reton IN 47670
Leeal Description
019-0054500 BROADVIEW 8
�' 1
O�.�ncr 1 First MidNe Last
V
�-A v ��� �l� �H vi S �
�c Addiecc (num6cr m�d svect, ciry. smtc. end ZIP coJc) ' - -' - --' -a' S:.mc u prapcm' nCd+ess—'- —' —'
�� y So, JJIJUC/!%v�•oa✓ �u, r��.� k��l. //J;.-�la�n �� (0 7V
$ocial Secu+iry Number pas 5 dieiLS) Ihivas LicrnsdS�ate IU Nmnber (laz� 5 dieils) Oiher (plms< specif in Pan 4 below)
��� ���-
SFrou;c First Middlc Last
Mailing Address (NUmbcr and stree4 city, smie. and ZII' cuik) � Swne � pmpeny add`as
Social Sccuriry� Numbcr (lact 5 digi�s) Drivcr+ Liccr�c/Statc ID Numbcr (la,t 5 dieits) Oeher (plesse spccifv in Pan 1 bcloa)
so¢
. � . �
Fach undersicned certifies, under penalty of pequry. [hat the aboee and foregoing infortnation is wt and co�rect and that he or she is zlieible to
receirz the homestead siandard deduction on this property. Each undersiened also understands �hat, by claimine additional homestead deductions
unlawfully, he or she may be liable (or back iaces and substantial financial penalties.
0..��rcr I Si�nenac Un�//�//O Tcicphonc ��/
Spou�e Simamre gie Tcicphonc
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