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� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Slate Form 5473 (RB / 4-03)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side /or liling instructions.
FORM
HC10
YEAR
� �e) �' �J �certify�that on.tMie:�st.day�o4Alaich. 20_
I(We) occupied as our princip place of residence lhe following described real property (or which a Homestead Property Tac C t is hereby daimed:
❑ I(We) owned ❑ Are buying under contract JU N� 2 2��1�
' Have a beneficial interesl in the enlity that is liable (or ihe property taxes on the property and tl�al owns the property�or is'buNng under a'conVaU.
if buying on conVad, Fee Simple ownefs name
oifica where conVaa is recorded
Tamship
If any pwlion of Ne residential sWCWre w the lantl not
ol the properry u6lized lo produce inwme.
one (1) acre
Record number � Page
Tsing aistrict (Nty, town,
Is �he
J � Real pmpeM ❑ Mobile Homo (I.C. 61.7-7)
surtounds lhat cture is used to produce income. descnbe Ne use and portion
������'���='�`��``���`'���' ��" 4:.. ��TRUE?AX ��� ASSESSED�VALUE Q HOMESTEAD�� NON�,-�RESf�ENTIAL "'� :
� °j �ASSESSOR'USEONLY�� �� VACUE� �' �AT1100°/a°OF'TTV��'iVALUER .t �. `�.RVALUE�`� '
z4aYi.5'�"c:a�dY3y`?� R'" sns � . _..1.. .G� ,. .>-.,,7,5 c'S.�F �.,.�`� ���1.'.r�.. .rl.3x.' i'�af��f�
Land not exceeding 1(one) acre immediately ''-3'�-sa;g ,,, �`° ��F
suvounding residen6al improvements. (�) . `� ,�� F�,,�����
_.�.���.�.�.�.. azn`,z� If:,s.,.�]`,%z.
e'ca"�°'
F-."- .kp% .
Other land (p� .-+,�,°�s+. "w�`r�
.d �s���5
Tdal land (line 1 plus line 2) (3�
`s�#`,'x`'�.f���;'� "F xtn i
Dwelling (4) �.�����y ��' �
Residential improvaments orMnualry
0.ssessad Moblle / ManufacWred Hortre Gara e u�� �.p�� r
f. c�,F .
9 (5) mi-�`�-'�a��'�r't����-�r
�� ��
Other im ravemenls (6) x � � �.
P r s .:+?.�'S`sa .
Tdal improvements (line 4 fhrough line 6) (�)
Tdal value (line 3 phs line n �g)
I hereby certify �he above is We, coneG. and SignaWre ofASSeswr Date signed
complele.
VaifyNg adion - Sig�ture oflwdiWr Date sgned
��i�-<''ta'.&���i��'��?�,�s'��s=�STANDARU::DEDUCTION'AL'COWANCEE:;'-�"''1�'a�� .��-aw z,r�s,,..-�".. ��'�.".�."����-�"'��y
20_Pay20_
Lesser W 1!2 Homestead $
vaivanon E35.000
Signa of itor Date signed
�
Gibson County Auditor
101 N Main
PRINCETON IN 47670
FILEI�
MAY 6 2011
C.'�.K " V
GIBSON COUNTY AUDITOR
t1�tEft1R\1!).'MIIL'IW+1
lRlAS11RFF Po0.M :3-IA
Individuab and rturtiN coupks are Iimi�N �o ore homeMeaJ sandaN Jnlunion. As ihe �emipi ol' ihis JcJunan becomc
murc bcneficfal. thrrc is more incrnm�e than e�er (or homesteaJ fquJ. Ilame�ttacl frauJ causes hi�her taa bills (or all; therefae.
HE.\ 1343-?(N19 requim uapa�en who rmive the hewnes�caJ standa�J dntuction m veril'y tlwt they are eliciNr m mc.i.e ihe
benefi� anf tu p�m�idr aikliiional idenurcirc� informa�mn nemmry to allua cwnrc ga'rmmmt tu bener monftor homesread
lilin�,�.'Ihis intnrmaiion w�ill M Aqw rnnfidcmial and r,�n nnle Fe arer:.nl h�� awhnniN munir nlT¢ials.'1'M1e IXpanmem of
I_ural Guvcmmem Pivnc< xill mc this in(ormuion W crcme twls that n'ill h:Ip cvunrv olTxials dimina�e humesrcaJ fvud.
• • ' ' ' , "
Tasparer Neme Prnoertc AJdress
Davis, John/Debra
2792
John Davis
717 E State
PRINCETON IN 47670-1911
�i�u��iu�i��u�ui�����iiu���i�inu��in��ni���n��i��u�
717 I° Smic 5'1'
Princeton IN i76J0
State Parcel tiumAer Le�al Descriotion
2Fr12-07-204-001.486-028� 019-01486-00 NS LOT 3 PT R3
� I First M�tltlle
��h� ��- � c=
g; 'd- i�iw�iu..; m�J� -c:t :iry'_"c W.,.Z:P'L_ ci ' _ _ — _ ..
� / ' ����G" S/ �//%CL T� .C� ,
Security Numbc� (last 5 digiu) Dm�er's Licenx/S�ate IU Nmnber (la�t 5 di�il) Other (pleazi
;-���� �
'c�� � I � c ��
Address (t�umber and 5Uee4 ciry', sule, and "LIP coJe)
� � rh� �C-: S� �e 1 �Z L� (`�0 itl
aurin� Numbtt (last 5 digiLS) Dm•crs Liccnsc/Statc ID N�unbcr (las� 5 dicits) Other (plcc
� - � �- �-/
��� lS
±me d ; my,ert� xdd.c<.. _ _—
�/76 7 d
� in Pan 4 bclow)
� �� � s
� S:une:tipmpeny:dd�cas
� y�� 7 �
spccif�� in Pan 4 Mlow�)
undersi�med certifies, under penalty of perjury•. [hat the above and foregoing infortnation is we and correct and that he or she is elieible to
re the homeslead siandard deduction on this propeny. Each undersiened al>o under,tands that, by claiming additional homestead deductions
+fully, he or she may be�iaple for back �axes :u�d substantial financial penalties.
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