Homestead_Davidson (3) FORM HC 10 1979 l - to Be Filed in Duplicate
Piescribed By Slate Board of fax Commissioners •- • -�%
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 7`/
SEE BACK FOR FILING INSTRUCTIONS
•
oL 7p ,NS f
SIWe) f v' °� G" certify that on the 1st day of
+larch, 19 1y I, e) occupied as our principal place of residence the following described real property for .
which a Homestead. Property Tax Credit is hereby being claimed:
I, (We) DT:owned
❑ are buying under contract -
ID have a beneficial int rest in the taxpayer Gyp
Property Description in G�//�County !�Y Township
Taxing District (City, Town, Township): f
Parcel Number I or legal description shown on tax statements o to(
J 0t. ,/o 0 I / /O
If buying on contract: Owners name uee simple ownerl
Contract recorded in'Recorders Office - Record No. Page
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 individual owns or is buying real property:. County Township
a_ gait
"thereby certify the above statement is true, correct and complete.
J. .! G5 .w 4 r� iz,o', Lt cr -/ 76 �o
'Signature Street Address / City. State and Zip Code
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 -
True Cash Assessed Homestead
Value Valuation Valuation
Land not exceeding 1 (one) acre immediately
surrounding residential improvements .pro r, (1) 56-o /70 / 0
Lr1 4, 5 ]979 (2) /7090 4-G1a '
Other Land Total Land a / d (3) /7�T o fl' - '%/
Residential Improvements wR ing''1
(4) 6 / 10
AttDITOp (6) - 0— /% ���%L'//'��y//
Garage
Total (6) 6 /9 0 -2 060 -6rp
o
Other Improvements (7) a ,"/� 36 'f�j�/j����
T•mprovements - Line (6) plus (7) equals (8) (8) r1 0.30 .7410
kj,by certify the abov is true. corre t. and complete. / 3 9'./o yea
14A0 •
Signature of Assessor Date
- ACTION BY AUDITOR -
Approved:
it - / Date: _6— 2s_,7y
STATE WWI 5351. MI TRFAStitTR MAN i•TA'�
.ArrET'ED BY ST.1TE BOARD OF ArrTAlSTs.a•.Y PRFYAIBw BY THE DEPART EIT OF LOCAL&OVEA:'MrNT FINAst'r n'LI.I-u-!.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple.are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than eser for homestead fraud homestead fraud causes higher tat bills for all;therefore.
®-f HEA 1344-2009 requires laapasers who receive the homestead standard deduction to verify that they are eligible to reecho the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
Olinty.This information n will be kept confidential and can only he accessed by authorized county officials.The Depanment of
Local Government Finance w ill use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Davidson, Lee L Trust
RI Box 113
Hazleton IN 47640
2734
Lee L Davidson
9477 N Salem Lane State Parcel Number Legal Description
Hazleton IN 47640-9313
26-02-47-004-000.138-017 009-00138-00 PT LOC 41-10107.01 AC
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
_Lem L0.verne- —�/ av�dSor
�se Address(number and atrmt,ciry sate,and ZIP cr4e)_. J Cme as property address •
Qy�� North SQIest, Lane, I-;a.zeI4onl "'n- y1 /,Qo
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) []Same as property address
__ —
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below) --_ _---_ - -- -
Marc
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
PART 4: ADDITIONAL INFORMATION