Homestead_Davis (18);���` `*""°- CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
� Sta;e Fortn 5473 (R2 / S92)
�e
INSTRUCTIONS: See reverse side lor filing instructions.
FORM
HC70
YEAR
� i3��
' CERTIFICATION STATEMENT ° � �
�.,
�e) certify that on the 1 st day of March, 79_
I(We) occupied as our princ' al lace of residence the following described real property for which a Hm+etYead �oq�ax Credit is hereby claimed:
IVUY V
❑ �I (We) owned ❑ Are buying under conhact � � , /�
❑ Have a beneficial interest in the eniity that is liable for the property taxes on the property and that owns the propp,ly or is in under a contract.
.. �� _->- ,� .
Ni;�:
�.. �:�r�� en 170R
� CONTRACT RECORDED `�� V � � �� � � �
tl buying on contract, Fee Simple ownefs name �
RecorCers otfice where conVact is recOrtled ' Record number Page
� PROPERTY DESCRIPTION
Counry TownsNp � Tadng tlistrict (ciy, town, fownship)
P r n mber Legaldescription
�b- b sia� � c,� -a-i � ,ss 3 ��
It any portion ot the resitlential strucWre or ihe lantl not ezceeding one (7) acre that immetliatey surtounds Ihat siructure is used to produce income, descnbe Ne use antl portion of
the OropeM utilized to produce inrnme. .
PROPERTY OWNED BV CLAIMANT IN OTHER COUNTRIES
Counry Township . Counry Township
ignatu e o daimant
I hereby certify the above statemenis are true, correct and complete.
.�-a�+
�dress (number anC streel, ciry, state, ZIP code) �
ASSESSOR USE ONLY TRUE A ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (� �
surrounding resideniial improvements.
Otherland (2)
Total land (line 7 plus line 2) (3)
. Dwelling (4) -
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 through line 6) (7)
ToWI value (line 3plus line 7) (8)
I hereby certify ihe above is true, correct, and Signature of Assesor Da[e signed
complete.
Verifying action - Signature of Autlitor Date signetl
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead �
Valuation or S2,000
Signature of Auditor Date sgnetl
0
Gibson County Auditor
701 N. Main Stre2t
Princeton, IN 47670
FILED
DEC 11 2012
_ C.`J.n�.,"-�ry
v�
1083G�BSON COUNTY AUDITOR
.T.\11
IP:ASLRFAlOF.LISIA
I lI�A�R Il' 0.::-L-f :
InAicidua6 anJ marrKVl mupli�+ arc limited to nnc honx�tmJ .tarni:rd drJuaiun. :\> iF,c recrfp� of :hi. Jttluc�ien becomr>
morc M1cncficial. Ihcr. ix rtrom ir,crn�i�c �han crcr for hoinc>tmd (mud Hwnc�tcad fnud caums iichcr m� bilk lor alh th-rcium.
IIIiA Ii{4-1q74 rcVUir� taspa.rn utro rcc:irc :hr homr>tcad wanJarJ dniuc�ion �o ctrify �ha� Um)" arc eligiNe ro recri�r �ht
hrocfii atxl m puniJc aJdi�inul idrmifi�inp ir.fixmaii�m nc:cwn� io alkwv cuumy em'cmmcm :0 6rncr nwnnor homc� �d
filir.u. Thi> intomu�im xill be Aep crnfidartial vnd can onk be acmaitl by audwnzeJ rnunq' o0icul.. The Dapanmam of
Local Go�crrr.wm fimncc ��ill usc �his infafmation �o cr.atc irnl: ;ha1 x�ill M1clp counrv nlTcul> climinim homc>�caJ Inud.
. . . � . . � . �
TaxoaverName LocationAddress
Davis, Grady P
Grady P Davis
1760 OuterLake Rd
PrincetonlN 47670-8884
Il�ll�ll�lli���lllilli�li���i�lil��li����ii��i��i�li���l�l����l��
7760 OUTERLAKEROAD
PRINCETON IN 47670
Il�lulll��lll ullu' ullull�l I��III ulull�ll �II�II�III �II�II I�I �II�I �II�II�I�I� II II
State Parcel Number Legal Description
26-12-09-104-001.512-027 PT SE NW 9 2 70 .622 AC
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.