Homestead_Davis (18)�.
�/FORM HC 70 1979 - To Be Filed�in Ouvlicate
Prtscri�e0 By State Baa�d ol Ia. Commissfaners
CLAIM fOR HOMESTEAD`PROPERTY TAX CREUIT FOR YEAR 19� �
SEE BACK FOR FILING INSTRUCTIONS O�q-o�s(p%.Qa
I, (We) �a--� ��� �• f�� � certify that on the 1st day of
�tarch, 19�, I, (We) occupied as our principal place of residence the following described real property for
hich a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial inter�e�st ,in the�taxpayer
Property Description in �--�-^-P� County ���"�P-� Township
Taxing District (City, Town, Township): �/Z�,T.�r�>J C.�,�-.��. 9
Parcel Number or legal description shown on tax statement:
,��R . �,�t- ? � ,� 9 .�-,E �
If buying on contract: Owners name �'� �""o'e °'""ef�
Contract recorded in Recorders Office - Record No. Page
If any portion of the residential structure or the land, not exceeding one (7) 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 individual owns or is buying real property: County Township
I hereby certify. the abo e statement is true, correct and complete.
� � � �� � � �
'S" namre Streec naaress ciry. Sta:e anaxf�• �D
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' 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
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
Total Land � � � 1,,�" ��
�: G`- �� r
Residential Improvemen r-� �
�vIAY 9 i9�.0
True Cash Assessed Homesiead
Value Valuation Valuation
(1) /S�? o �"o 0
(2) —
�s� isa o
Dwelling �4) i o
Garage (5) ��SO
r Total .
� �� � �
Other Improvemepts; �i �q-�n?4�.�`�'
Total Improvements - ine (6) prus��(7� equals (8)
1 hereby certify the above is true. correct. and complete.
Signarore oi Assessor
(6) ���
( 7 ) -��
(8) �
- ACTION BY AUDITOR -
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Date:= �-•-�--�o
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
3905
David L/ Lisa A Davis
418 W Cleveland ST
Princeton IN 47670-2906
nae waa ��w�� i.-r�
*w;�suaExwn�tain
Cqr1YMR.i iP'a�CE IC61.12]J.I
Individual> anJ ma:riN coupl� are limned �o oce home�eaJ �andaN d:�lunion. As �hz receip� of thi> deduaion hcome±
merc beneficial. ther< is morc incemn�e Oun ecer for homesieacl fraud. Nomesttad fmud eausc� hi�her tai bills tor all; therefae.
HEA lii4-?fH19 requirn u�pacen x$o retcire �he hanes�eaJ AandarJ JeJunion io verify the� Ihey are eliejMe lo mtei�e Ihe
benefi� an1 iu prm�ide aJJiuonal identiivim_ infurtnatiun necrss�rv to allow counn� eaemment ro bzrter moniror homeneaJ
filin��X- This inlarnviinn will M Ary4 cm0�?emial anA can nNy h: acaeiuA hc au�hnrival eounn� o�iicivls.'fhe Ikpannmm nf
Local Gwemmeni Fitince ��ill u�c thfs fnformation m arcam cwls ihat will hclp cvunn� olficial. dfmmatc trc�m<stcad kaud.
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���ii��n��i��n�in���iun�i����i���i�n��inn���n����ii��
Taxparer Name
Davis, David L/ Lisa A
State Parcel Number
x 26-12-18-301-000.567-028
Propert�� Addre�s
iIS W Cleveland ST
1'rinceton W 47670
Le�al Description
019-00567-00 BALDWIN HGTS 7/8/9 BLK 8
1' 1
O�.na 1 First Mfddle Lut
.�0.tJi� � J�Q�iS
g Address (numbcr ond sace4 city, state, end ZIP code) "'-- -- .. .-- '�— —� —� eme as propem oddn.s� �
/g �A%, �level4nc( /-}-✓� �fi nCe.� .�I�i �-17l�i0
$ocial $rcurily Number (las 5 di�iu) Dnvers License/State ID Nmnber (Iait 5 di�its) O�hrr (pleue specify in Pan 4 below)
S�au;e First Middlc Last
�i's� A� l�a��'S
Mailin_ Address (�umbrr and streeL cii}', sWle, end LIP cale) .�Same u p�openy add�a
� v.J, /eve(cc.n ve �/'�'n ce� � �7�70
Social Securiry Number Qaz� 5 dieirs) Drivers License15tace ID Number Qa;t 5 dieits) Other (picase spccify in Part: below)
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Fach undersiened certities, undzr penalty of pequq�, that the abo��z and foregoing information is we and cotrect and that he or she is zligible to
receive the homestead siandard deduction on this propeny. Each undersiened also understands �hat, by claiming additional homestead deductions
unlau�fully, he or she may be liable for back taties and substantial financial penalties.
O�mer 1 $i¢nature Date Tclephonc
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