Homestead_Lasley (2)Si1{F
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (Fi2 / S92) �
FORM
HC10
YEAR
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INSTRUCTIONS: See reverse side (or (ling inshuctions. ' �
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r � TI ICATION STATEMENT
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I(We) G G�} D G1 certity that on th�6t�ay'lm 1a1aYs�?t�9_
I(We) occupied as our princip place of residence the f Ilowing described real property for which a Homestead Property Tau redit is hereb�!claimed
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❑ I(We) owned ❑ Are buying under contracb -�
❑ Have a beneficial interest in the entlry that is liable tor the property taues on the property and that owns the property/�ygk�yind" der'a'eqna�6'�?jOR '
GiBSON CU
CONTFiACT RECORDED
It buying on coniract, Fee Simple owners name .
Recordels office where contract is recorded - Record number Page
PROPERTV DESCRIPTION
Counry � Towns ip � Taxing distric� (dry, .(ownshr )
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Parcel nu/rt�e r Legal description
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If any portion of ihe resitlential swc[ure or ihe land not e:ceetlirg one (1) acre that immediatey sunountls �hat siructure is used m protluce income, describe ihe use and ponion of
Ihe Droperty uu7izetl ro produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County Township Counry 7ownship
Siqr+c�2pf daima �
reby certify the above statements are true, correct and complete. � �T
Atldress (numberandstreeC ciy, sfate, Z/PCOde) I^
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
land not exceeding 1(one) acre immediately (�)
surrounding residential improvements.
Oiherland (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) �
Total value (line 3 plus line 7) (8)
I hereby certify the above is irue, Conett, and Signawre of Assesor Date signed
complete.
Ventying ac6on - Signature ol Auditor Date si9netl
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesse of 1/2 Homestead $
V lu on or 52,00
Signature ot AW imr �a�}9= �(.� _ l
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
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STiiE fOR\I!l%/ 12' / Yl�l
TPFwSUW Po0.411n
Indi��iduals and ma;rieJ rnuplc are IimiieJ to one homr�eaJ �anAaN d.l:du.�ion. As Ue rttcipt ot L'us daluctan t+ecomc
mure benencial, thae i. morc incencne ihan ner for AomateaJ Gaud. HomottaA fra�a1 causes higher im� bills (or all: thercfae.
HEA Gi3-?0(!9 «quircs taipa�ers .rha reccire the hanes�ead smndard deJuction a veri(y ihat Ney mc eligiWe m recene tAe
brnrfit an1 ro ptw'ide addiifoful idrntiiyin_ infumiaLan neassary to allw' counn� go�'rrnmml to bet er monitw Iwmesrc:d
filim�. ihis information xill M Aery confiduuial anA can only M arcecseJ 6� authorieN tnunty oflici�s.'I'6e IXpanmrnt o(
Local Guvcrmnrn� Fi�ucec ��ill mc this information w crcam twls that will h:ln �wnn' olficial. climinatc homc.rcad hauJ.
522
Rodney S/ Paula D Lasley
R4 Box 180 B
PrincetonlN 47670-8102
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T•rapaver Name Pruperte Addretis
Lasley, Rodney S/ Paula D I
� Hs �;o� i so i3
I'rinceton 1 I 4767 �
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State Parcel Number Leeal Descri�� tp ion
26-11-15-100-003.722-027 M C ROBERTS TIChiENOR RD PH I 1
/ D-17
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This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county
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Address (nurt�er ond �¢ee�, city, sm[e, and ZlP codc)
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ecurity Number (las� � di¢its) Driver's Licrnse/State ID N b
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First
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Qast 5 digiL) Oeher (plcice specify
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� Address (Number and svee4 dp', sW1e, and "LIP cak)
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Saurity Number (last 5 di¢i�s) DrivcYS Li .e/State ID N ber (la,� 5 digi
MidJlc
La.s �
ns pmpem odd�¢s
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Part46clow�) i
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:u oronenv add�as
Other (pletice spoEify in Part: Mlow)
urer.
idersiened certifies, undzr penalry of pepuq�, that the above and foregoing information is We and correct and that he or sfie is elieible to
the homestead standard deduction on this propeny. Fach undersigned also undentands that, by claimin¢ additional homeitead deductions
dly, he or she may be liable for back taxes and substantial financial penalties.
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