Homestead_DavisWflM MC 10 1979
Preu�iGeE By S�ate BoarO ot Tax Commissioners
io Be Filea in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT FOR YEAR 19 �9
SEE BACK FOR FILING INSTRU
��(We) ��—� �' ���� ��xd certify that on the 1st day of
�vlarch, 19—%�, I, (W occupied as our principal plac of residence the foliowing described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) Q'owned
❑ are buying under contract
❑ have a beneficial inteJrest' in the taxpayer
Property Description in�d.6�^� County
Taxing District (City, Town, Township): �
Parcel Number
If buying Ofl contract: Owners name ��ee simoie ownerl
Ob(� �DDy09
Township
or legal description shown on tax statement:
� ; .
Contract recorded in Recorders Office - Record
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
' 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 ON�Y -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land � � �,
Total L �
Residen� Improvements
,1UN 819�
Dwelling
Gara9e
Total
Other Irr�iem s
_T•^•-'-Improve ents - LineR��s� (7) equals (8)
i�oy certify the above is true. correct. and complete.
Ass¢ssor
True Cash
Value
(7) So 0
(z) 9 4_�
(3) ��
(4) t P3 s9
cs� —
(6) �35a
(�) —
(s) �83s�
s[.ju�m�n■nr•�:s
Assessed
Valuation
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Approved: � � � Date: �
1"
Homestead
Valuation
�_wc�.'
Gibson County Auditor
101 N Main
, PRINCETON IN 47670
�
112 .
S�ARFO0.N!).W IL/>wl
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iRF.�1uIS0.f00.4.�S1A
Indi��iJuaL+ and m�:riN mupin arc limiied �o orc homr..tcaJ xand:N AeAu.�ion. As the rmtipt o1 this dedunion bttronre�
mure hneficial, there is morc inrenme than e�er for homnteyl fraud. HomnttaJ fmuJ causes hicher tac bills tor all: thrrefore.
HEA 13J-i-?OQ9 requim ta�pa.en ��ho recei.e �he hanescc+J sunda�d Jnfuction to .erity thet thry are eliciNr to rxene �c
benefii aN w pmeide adJitio�ul identii�'in� infomu�ion naevan� to allou' counry garmmmi ro betrcr monimr homesrcaA
lilin�.'Ihis infomuiion will be Aery contidauinl anA can onl�� tt accesinl by authorved rown� ofTiculs. The Depannrm af
Lur�l Gu�'emmem Fivnc< will ux [his intormation ro crcam ewls Ihat �cill h:lp cvunn' olixtials eliminam Irom<sttad (raud.
CaNin J Davis
425 E 200 S
PrincetonlN 47670-9265
�i�ii���i��i�����i�����ui�i�ini�i�i��in�i�ni�i���i�i�ii���
Taspa��er \ame
Davis, Calvin J
State Parcel Number
26-12-19-400-000.409-027
Y
Prooertc Address
RI 1 '1v
��.
Prince�on IN 37670
Leeal Descriotion
OOCr00409�00 PT SE 19 2 10 7.1405 AC
D10
Dana I � � �j/� Firstl Middle � � �
G �iYr�s � cv�
ig Add�s (number and itme�, ciiy. siate. and "LIY code) .._ — -"�S�mc m piop.�rty a1.Las '
� �� 00�; ��/�t/Gc'%ic% �T/. %�
Social Security Number (lan 5 die�u) Driva's Littnse/Sute ID Number (lasl 5 digils) Other (plesse spaify in Pan 3 6elow)
� �—�. �
'��� I
(t.mnber and svice4 �p'. siate, and ZIP code)
Stturiry Numbcr (lazc 5 dieits) � DrivcYs Liccn<c/Sutc ID Niunbcr
� S:une:u piopeny addres;
spccify in Pan 4 Mlow)
7�
undersi�,med certifies, under penalty of perjury, that the abo�•e and foregoing infortnxtion is true and correci and that he or she is elieible to
:e the homestead standard deduction on this propeny. Each undersi¢nzd also understands that, by claiming additional homestead deductions
�-fully, he or she may be liable (or back taxes and substantial financial penalties.
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