Homestead_Lasley� CLAIM FOR HOAAESTEAD PROPERTY TAX �G FoRbl Y�
CREDIT/STAtdDARD DEDUCTION
swa wm, srr� rti� � s o� �
P.�es�ed by Ihe DepmVnent of Loral Gorerrcnerq Finanm �
INSTRUCTIONS: See ievarse side (a Ring ins6uctions.
� CFR7iF7CA7IWi STA7ENENT
� �e) _CJ.AL$ � • . • � t_�1�� `� � �C�� 1�� ihat on tlie 1� �''�'"''/`�''��'
I(We) occupied as ow prind�e p ace af residence the tdlowirg desvibed real poperty for whid� a Hm�estead Prope��al'wad�he�e q�pITOR
autv (;�UtJTY
� �(We) owrxd ❑ Me buymg urdes oontrad
,J Have a benefidal inmrest in C�e enfiry that is liade fw ihe poperty tazes m ihe property and tl�at owns �he property w is buying under a contracL
- CON7RACTRECORDm �:�- . '
tf hy'rg om m�trac�. Fea Simpe wmers reme
Re�defs o�ce'M�ae mNaa is remded Recard num6er Pepe
Caia�ry
Pa�cel rvuribar
rvur ber
}'1/1 �_ .— -r� f 1 /'15T ,. 7`
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... PROPEFi
Tartchip
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� Imd rwl m¢eeding one (1) eva Mat i
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i�elY wrtov�
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question:
�eal praparty ❑ MaEile Fbme (/.C. 61.1-7)
ra ia uead b pioduce ewome. tleafibe Iha tae and portpn
� ASSESSOR USE OiiLY � ..�� � .. :."� °, 7RUE TAX. ASSESSED VALUE HOO�STEAD � -. . . , NON�tE51DEN71AL .: �
� � �. �.. . �. . , � . : . � . . .+ =t � , VAUIE. , , -. . �AT,100X OF TN '. - VALUE $ • ' ., ,. : •,, VILLUE - � . ... :_ ..
Land rrot excecdi�g 1(one) aae imnec6ffiely , . . , ...
surtoundug residential improvements. i�) . - '
Otl�er lard (p� .
T� IarM (!6re 1 pku fine � �3)
. Dwel6rg (q) � . . . .
Resdential improvernents or Mrwaly . . . .
w............w AlOh172 / �A3fp1(HC�MEd FIOff1B � . .
Ci3f8(JE �5� ' . � .
Da1Cf YfIPfOVCIf1Ef115 �s� .. .
Tcial vnprovements (fine 4 throu� line 6) �7�
Tolal value (line 3 plls Gne � (g)
I hereby certily the ahove is true. mrted� ard S�Biat�ne m/��essv Date si�ed
canplete.
vairying aaian - S�mtae of piCimr pate sip��ed
Gibson County Auditor
101 N Main
PRINCETON IN 47670
tlitElORN a� W IR�/ 4M1
I �V
� iRFASUIFAPoA4:}1.�
IndividuaL. and nu:rieJ coupb a�c Iimi�N �o ore homeunJ .taiMaN dedunion..4� Ne receipt ol thii deduc�ion bttonm
more beneficial, thrre is more incrntne dun e�er for homestexl &aud. Ilomo�racl fiaud causa hi�her �a� liill� tw all: the¢fur.
HEA 13ii-ll%W reqvim u�paym r.ho �eccire ihe homestcaJ standaN JNunion tn .eri(y tiv� �hey are elieihle m meei.e the
benefii anJ ro pnn'idr mMfi�ional identifrin� infumi:niun nemsarv tu alluu� counry� gucemment m beve� moniror humrs�eaJ
filinf�_ Ihfs inl'mmation will M Ary4 cmliJenlial and can only he actec�ed b�� autMri�ed coumy o(Tciul: The Ikpannxm o(
I.ocal Gw<rtvnent Fna�rce �.ill u�e this inio�muion w ercaee twls that e'i0 h:ln mmm' o�inals elimirate huncttcml fiaud.
1075
Robert A Lasley
2029 SW White Church Rd
PRINCETON IN 47670-9322
I�I��II���I�II��i���lll���l�l����ll���l�l��l�l��l�ll�l��l�l��l
�g Address (num6cr und �ucet city, smtc, and ZIY code) �
9 Srd (.�I " �E � v �
$ocial $ecunn Yumber (last 5 digiu) Drivers LicnueJSlate ID Nmn r(L
/.,�� ��
Taxnacer Yame
Lasley, Robert A/Deann Parker
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5 dfgil
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-l�.�A.�/� � �.
c Address (Number md evttS ciiy, s�ate, and'LII' cpfe)
S f�M�
Stturity Numbcr �laa 5 digi�) Drivcr's LiccnsNS[atc ID Numbcr (la � 5
�« �
� W FiiT efiN�QC//� �
iQ-W..-196?-
�-rrc� e7o �K
State Parcei Number Leeal Des
2fr11-14-100-001.20&027 oos-o12o�ooPT
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ac prapeny udtiry;' '
'r�RK��
�e :u pmprny addres
Each undersigned certifies, under penalry o(perjury�, that the above and foregoing infortnation is we and correct and that he or
receive the homestead standard deduclion on this property. Each undersicned al>o understands that, by claiming additional hom
unlawfully, he ot she may be liable for back ta�ces and substannal financial penalties.
n
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14 2 11 11.92 AC
elfgible to
deductions