Homestead_Lashbrook (4)INDIANA SALES DISCLOSURE FORD
J. ROBERT KINKLE HALL, PARTENHEIMER & KINKLE
Prepner o(tbe Sales Disclamre Form
N9 N. HART ST., PO BOX 13
PRINCETON, IN 47670
On•% Slate, and LP Code
SDF ID 26- 2009 - 1000422
ATTORNEY
HALL, PARTENHEIMER & KINKLE
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6 Page 2
IE. SELL-ER(S)CRANTQR(S):
WILLIAM J. WORNICA JR.
Seller -.Name as appears art eomvn'nnre docummr
100 S. COLLINS ST.
Address (Number and Stmel)
FRANCISCO, IN 47649
(
Jnder penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and
omplete ass equired by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ".
Si�na;um aJ Sel/er �p rmnrr plSeller
(cJ,'/)1`QmS [c�U/✓)1'ccu_�2 j -z k;.t cj W0r1\jCC4 -Z �o
Primed Name o(Sefler Sicn Dale (.A1AVDD,TYYY) FPrWe,T1V4uue of Seller Sip Dare MIM,'DD .11 T1
[F-BUI FR(cvf NTEE(S) `APPLICATION FOR DEDUC,TIO`S'AND'CREDITS --'IDENTIF.Y ALL ITEtiv1S THAT-APPL] -
PAUL T. LASHBROOK
�, rs on cam'rranrr a�emnrnr ��
'Box 124
Address pVUmMr and surer)
FRANCISCO, IN 47649 -0127
(,- 3.
HeatinglCooling Svstem
F- 5. Wind Power Device
r 6. Hydroelectric Power Device
F 7. Geothermal Energy Heating/Cooling Device
r S. Is this property a residential rental property?
F- 9. Would you like to recieve tax statements for this property via
e -mail? (Provide contact information below. Please see the
insirtrctionS far more inlonnatimt. :Vai available in all cormriea.)
l.fW -/V %-7 - (J V - L-tee
ON. Smte. mrd7JP Cade Cou"N Primmn•pmpem -onmer roman none E-mail
IJ
HATE FORM (*,R_1•.••1 TREASURER F&M IS-SA
.ArIMMED BY Er1TE 13.M.K011f A(rvts'n.n.Y PRFAAIGFP BY Tr.DEPARTMENT(FLOCAL ea>r0.MMETT Fa:A42Mll.t-l`11
Gibson County Auditor
1Q1 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 IndividuaLs and married couples arc limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than net for homestead fraud.Iomestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verily that they are eligible to receive the
benefit and to provide additional identifying infonn:nwn necessary to allow county government to better monitor homestead
filinge.fins information will be kept confidential and can only be accessed by authorized county officials.The De annent of
Local Government Finance will me this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address •
_ Wornica, William J Jr/Christina L
Po Box 311
Francisco IN 47619
4611
Paul T Lashbrook
100 S Collins St State Parcel Number Legal Description
FRANCISCO IN 47649-9281
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Pa �, S L svmbc- :ol,
g Address(number and street,city,state,and ZIP code) g Some as pmpem address— _. _—- _ _. _ _ __
\ S. e '\; (MS S • VCArcdSCO , _ k-A1LOL-kq
Spouse First Middle Last
SY ThC.I PTheriere._ \ "b
Mailing Address(Number and street city,state.and ZIP code) ® Same as property address
\OO S A\
C \;nS . �rAc�CUScc) 1 �N Uf194 1
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Si attire Date
PART 4:ADDITIONAL INFORMATION
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