Homestead_Davis (19)�
Gibson County Auditor
101 N M3in
PRINCETON IN 47670
ia%o
Eddie W/ Davis
2007 S 175 E
Princeton IN 47670.8723
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IndiriJuaL. and m�:riN couplec are IimiRd io onc hnmcaeaJ �afMaN J,�riuniun. �s �he recttipt ol iFvs Jcduction bccm�e�
more benencial, ther< is morc incencire dun ocr (or homestraJ fraud Ilomesead taud causes hi�hrr tan bills (or all; thcrtfae.
HEA 1i41-?GW requim uipayen who recei.e ihe hanrs�raJ c��nda�d dvluction to .xrifi� tlut ehey ve elieide to mcene ih.
benent ant ro prm�ide :xWiiiunal iJrntifring in(orm;mun Ma�+arv w allw� cwnn �a'rmmmt ro beircr mmi�or homs�ead
filin�. �Ihis inlortnalion will be AqM eonlideNial anA r�n nnl)' h. aettoN by autlror'vn1 rounly oRciais.'fhe Ucpanmcm nf
Local Gm'<mmrnt PiwM'e wiil u�c Ihis information w crcatc [vls dut �rill hdn rnmn� ulTiriaL. dimiwtc hemcmad frnud.
���u��u�����u�in���ni�n�i��n�n�i�u��i��ni�in��i�n�
Taaoacer N•rme
Davis, Eddie W/
State Parcel NumAer
26-12-21-300-000.4 28-027
Y
Propert�� AJdress
R ? 13ox ��
Princcton�
Leeal Description
OOCr0042&-00 PT SW 21 2 10 9.84 AC
D-10
�' �
Owna 1 First Middle Last
E�( ol i e Wesi" A v i S
�e Add(ecs (numbcr and irmct.—cirv, s�dtc; andZlN ca6ej --- � --- �� �Semc u, prupeny nddrev-- -- - -
�00� S 175E {�rince%oh -� a�� � "u?67�
Social Securiry Number (last 5 digiu) Drivas Licen�tam ID Number (la.� 5 digiu) Other (plcsse speci( in Patt 4 below)
°�
,. . �
Each undersibmed cenifies, under penalry of perjury, that the above and foregoing infunnation is we and corrzct and that he or she is eli�ible to
receive the homestead standard deduclion on this property. Each undersi¢ned al>o understands that, by claiming additional homestead deductions
� unlau�fully, he or she may be liable for back taxes and substantial financial penalties.
Owncr 1 Sicnature Uate Tcicphonc
.�� � � �
i
„ R•� t CLAIM FOR HOMESTEAD PROPERTY TAX
- = CREDIT/STANDARD DEDUCTION
t � Slate Form 5673 (RS / 10-01)
Prescribed by ihe Department of Local Govemment Finance
INSTRUCTIONS: See reverse side lor �ling instnictions.
FORM � YEAR
HC10
I(VJe) C �'�! O��� /Q� �,r� certify that on the 1 st day ot March, 20_
,I�(We) /occupied as our principal place of residence the following described real property for which a Homestead Property Tac Credi� is hereby daimed:
Ltl X(We) owned ❑ Ne buying under wntract
u
�Have a benefidal interest in the entity Nat is liable (or the property Wxes on the pmperty and that owns the property or is buying under a wnUact.
I( buying on conUact, Fee Simple owners name
Counry
Parcel number
If any po�-. I lh
at �he omoeriv WI¢
contraclis recorded
7amship
���' 1 I Le al tles� i/` V
'cl/ C �
sWCture w the Wnd not excaeding one (1 � aae
ice income.
Record number � Page
township)
I Is the propeM in question:
❑ Real Droperty ❑ Mobile Homo (/.C. 61.1-7) .
surrounds Nat sWCUre is usetl to produce income. desaibe ihe usa antl poNon
"'�”' '��.'`: �'��4'^'"�c�Ct . ,��s 5—� � � ti,. . �..-
`''f``�� '" �-��s-*` + TRUEoTAX ASSESSED VALUE �' HOMESTEAD ��' NON-RRESIDENTIAL ri
c� ASSESSOR�USE ONLY'� 2� .'.�' iVALUE
�2,� '�k'�."�.P����45Tr7�� a$t�3%Si�3......�."-�-s.i�.cn"�+"�.'� `¢7-�+�'i.VALUE�"-�� ��"AT4100%OF,iT]Y� �r VALUE�� C���^x..�..-..�..�`.s.�i."`���
Land not exceeding 1(one) acre immediatety �:�� t,�$ ''��'�"# ���,".-'fx
, n�i:,-.
sunounding residential improvemenLS. (�) �''"�°"3 "3�.��' '" �
{�c 'i�i�a-�.t. 2`s{i.
kFS�' ��- :4
Otherland (Z) ��� �, .�
•-�=��
Tdal land (Gne 1 plus line 2) �g)
. .f'rs. "°`l`F ri v�" ��P:-':
Dwellin9 (4) �� i"�� ���`A*4%f��.�
Rasldential improvements �`��^� �^��+"��� hT;'
� �� -� �s.'� n. �
Garage (5� �
t'�+:'fs,i.x�YA --,j.F._2:�'y{'s,
Other improvements (6) ��-s��,�'`y ��
r:�.+. �,. �Y`_Sa.. ,a�-�
Tdal improvements (line 4 th�ough line 6) (�)
kial value (line 3 phs line � (g)
I hereby certify the above is We, correcl, and Signature ofAssessar Date signed
complete.
Veri(ying aclion - Signature otlwdiWr Date signe0
` . _... y„ � � _,y}4r .� .v.e. ' .r , : ' : - • �.+ .9°— . Y k��jb��" al Fi
:�.��.- . ��� r�.�t�C�`�.�''�i„ �`.��"srnNOaan.oEOUCnoNUiow,nNCe�..�'"�.�-`"�i;�'. �:�::�y -�`.u:_.� = - "_� =
x��. �
20 _ Pay 20 _
. Lesser of 7!2 Homesiead
Vaivatio or $6,000 5
SignaWre o Date signed
0....