Homestead_LashbrookWRM HC 10 1979
PreSCriDM By S�ate Baa�G af ia. Commissioners
CLAIM FOR HOMESTEAU PROPERTY TAX CREDIT FOR YEAR 19 �9
7o Be FileG In DuO���a�e
SEE BACK FOR FILING INSTRUCTIONS
�(We)��G^+-•-� ����- ���-��� /'G�cer�tif'y that on the 1 st day of
arch, 19? �. I, (We) occupied as r principal place of residen e the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) �ownef
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
�°�"� Township
00�'Dl���
Property Description i
Taxing District (C'1},• T�Township):
Parcel Number ��
If buying on contract: Owners name �'� 51np1e Oxne'�
or legal description shown on tax statement:
�.SE �y ��-2-�0 � ��
Con[ract 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:
�h� ydc�rtify the abov statement is true, correct and complete.
/-�OxQ�., n _ , n ., /1
Aaare55
County Township
an0
' 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 -
Land not exceeding 1(one) acre immedia�
surrounding residentiahRllT��OeT(�nts�
Other Land �� 1 L
Total Land
Residential Improvements ��N 12 �979
Dwelling
��/�j4�Garage
�
AUDiTOR Total
Other Improvemenls
T� Improvements - Line (6) plus (7) equals (8)
I eby certify the above is true. correct. and complete.
True Cash
Value
(�) So 0
(2) �'/(o 0
(3) /5�l0 0
�a� i�oao
(5) �3 0
(g) / o S'so
(�) 9So
�8� � i �oo
Assessed Homestead
Vaivation Valuation
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Date
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Date: — _
�
Gibson County Auditor
101 N Main
PRINCETON IN 47670
i
IiRfANt2fO0..N:}I�
PRLXW➢QIBY i➢f DElM1MNf UF L0.AL G0�2AVMITT iQ:�]CE ICH.IS-1.1
Indn�iduaL� and rtu-rinl coupi�� a�c limi�ed to ore home.tnd :undtN dNu�ion. As ihe rmtip� oi Uti:� dNunion bccomcs
more bcneficial. thrrc is morc fncentne ihan ner for M1omtsteaJ ftauJ. Iloma'ttad (rauJ cau.� hi�her us bilis (or all: thrrefae.
HEA 13�ti-�O(19 requires uxpaqers w�ho rmivc ihc hancs�caJ standard �kvluaion m.erily tfw� �hry' are elieiNc io mcei�r the
benefit anl io pnxide :¢kliiioiul idrntiipfn_ iniurtnatmn nemvn ia allw� county gv.rmmenl ro beve�� munitur homesteaA
filim�. Ihis in(nmution will 6e AryY confiJcnlial and ean onl}' h arcr: •ed b�� amhomnl rounty oliKials�'ITe Ikparlmmt n(
Ta�oa��er Name
Lashbrook, Roger Dale / Marilyn
Rexene , �
e�
0`�
4112
Roger Dale / Marityn Lashbrook
3244 E 350 S
PrincetonlN 47670-8750
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1 First
�oGc� �l ALG
g Addxecs (number end sveet. city, smtc. and ZIP code) �' '
�a �� � . J sz� s. � Pr �� ✓1Cc:�m ,T .
$ecurity Numbcr (last 5 digiu) Ihiver's License/State ID Number (laV 5 digils)
3SoS.
1'rince�on IN
State Parcel NumAer Leeal Descrip'tion
2612-27-400-001.175027 o0i>-o1175-00 PT SE �27 210 5 AC
✓ o-,o I
,j,As H�� oo ,✓
Seme az pmpem addrQ;
(pleasc spcciH in Part 4 below)
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Address (f.umber anJ sYrtt4 city, swte, nnd "LII' a�de) S:+me u pmpeny adJ�
��
'a � . So s.
:curity Numbcr (last 5 digiCS) Dmcrs Liccn�c/Sta�c ID Nwnbcr (la;t 5 digits) Ochcr Iplcuc spcciN in Pan 4 bcbx�)
- ._ ._ �,
undersigned certifies, under penalty of perjur}•, that the above and (oregoing infortnatiun is we and colrect and that he or stie is elieible to
�e the homesiead siandard deduction on this property. Fach undersiened also understands tha4 by claiming additional home�itead deductions
-fully, he or she may be liable for back [axes and substential financial penalties.
I $icnauue Uate Telephone �
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