Homestead_Davis (28)^CLAIM FOR HOMESTEAD PROPERTY TAX vEAR
,� 't CREDIT/STANDARD DEDUCTION HCRo
Stata Frnm Si73 (R8/7-07) �
� �. � P�esubed by Ihe Department of Lxal Govemment finaxe �!? �
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INSTRUCTIONS: See reverse side /or filing insWctions. -1� J
- . . .
��WQ) certify thaty_7� Ihe i s d y of March. 20_
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I(We) oocupied as our prindpal place of residence Ne fdlowing described real property fw which a Homestead Prope hereby daimed:
�I(VJe) owned ❑ Are buying under contract GIBSON COUNTY AUDITOR
Have a benefidal interest in the enfity that is liable fa the property tazes on Uie property and that owns the property or is buying under a contract.
If buying on coniract Fee Simpe ownels name
where conirad is recortled
Twvnship
Tacing district
�s �e
vvv-�a�tJt�-�1u/-{-��� •dfl d`7k� / I
If any por6on of the residenGal sVUCWra w Ihe IaM not exceeding one (1) acre that immediately surrounds that
d. ihe property utilized lo produce inmme.
( Record number I Page
fm sNp
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in ques6on:
1 R�� o�cam ❑ Mobile Fbma (IC 67.1-�
wre is used In pioduce Income, tlescribe the use and portion
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Land not exceeding 1(orre) aae immadiatety '� ''- � ..{` �
surroundingres{dentialimprovements. (�� .. . -� � �
Other land (p� � � � ' 't� '
TUaI land (line 1 plus line 2) �g�
.. ? `
Residential improvements w Mnualy �e11i� �4� `� � z _. ;-. � �
Assessed Mobile / ManufaUured Home . • .. - ; � -
Garage (5) •�.'-rz.��_.-::','..,�:.
Other improvements (6) � � .'
Tdal improvements (Irne 4 throuqh line 6) ���
Tctal value (line 3 plfs line n (8)
1 h¢reby t6rtify Ne above is We, cOrteU, aMl S'r,,naWre ofASSessor Date signed (rtanlA, day, yea�
complete.
Vaifyi� action - SignaWre oflwtlitor Dale signed (mmfh, day, yee�
�— Pa1' Z� — 45.000 for 2007 pay 2008 42.000 for 207 0 pay 2011
Lesser of 12 qq,000 tor 2008 pay 2009 47,000 for 2077 pay 2012
Homestead Valuabon
� ^ 4�00 for 2009 pay 2010 40,000 payable afler 2072
�
Gibson County Audilor
107 N. Mafn Street
Princeton, IN 47670
575
.;.vi mxv ,w�ti �.ie�
iatwcuux �ortv rsi.�
IndiviJual. anJ marrrtyl muple. are IimitN m onr M1anr.ac-ad sia`xlud ihvtuaion..\ �he receiry af ;L6 JeJuniun becoma
morc hncfteiai. �hcrc is more ir.crn�i�c ih�n c�.r lor hmnc.�uhJ (mw1. Himxamad Gau1 aav=r• iie5cr uc bill: lor elh th rc(or_,
HF.:\ 13J1-?INN rcyuir.s uspa.m wio «Yeive :hr home�iraJ �tanJud dedue�ion io ceri(y A:a� �hey arc eligible �o rttrice �he
frncht anJ io prrn�iJc mfdiiional idcmitying ir.fixmaiion nc:c<.uro io aII.M� ttumir emcmmcm to ba¢T m.niior hort:c�.�d
filine�. �fhin inlormation x'ill h kepl con�iJemiel znd oan onh' bc vac.seJ hy amhurized cnun�r nflicia6. The Depar�m<n of
Shann A Davis
256 Lake Inwood Dr
PRINCETON IN 47670-8678
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Taxpayer Name Location Address
Davis, Shann A/Kimberly 5
256 LAKE INWOOD DR
PRINCETON IN 47670
II�I�IIIWUIII II I II IIuII�ulllululll ul �Ilull�lll �Ilululull II luull Il�lul� II II
State Parcel Number Leqal Description
26-12-06-201-001.298-027 wcE INWOOD 11
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.
tr.� I�I.R-�n- r;��l �,
ing Address (numbcr and svcct, ciq�. state. and ZIP code)
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Address (�umber znJ �:+cet�cit �.` iaie, and'I.IF code) . - `_ ��
�GLvrS
�mc zs propcny add:css
Other (please spec:fr ir. Pan 4 bclow)
� Su�
Middle
�ct,v� S
f—I Same as pmperty add.-ess
, LT . t�__—'_'..___'._
Other (pleue spe::fy ir. Pan 4 b:lo.r)
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undersiened cenifies, under penalty of perjury, that the above and foresoing inlortnation is true and cortect and that he or she is eligible to
�e the homestead standarcl deduction on this properry•. Each undersienecl alsu understands that, by daiming additional homeste,ad deductior
; fully, he or she may be liable (or bach taxes and substantial financial penalties.
1 SigrmNrt Date Telrpho�
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