Homestead_Hyneman (9) STATE FORM 53569(R818-I0) TREASURER FORM TS-IA
AF�'ROYED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCEJC6-LI-22-8.1
IMPORTANTNOTICE TO HOMESTEADPROPERTY OWNERS - '
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
•auses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
standard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
information necessary to allow county government to better monitor homestead filings. This information
• will be-kept confidential and can only be accessed by authorized county officials. The Department of Local
- Government Finance will use this.information to create tools that will help county officials eliminate
— "homestead fraud. ' -
PART1: PROPER Y INFO'MATION - ,.
Taxpayer Name Property Address State Parcel Number Lecal Description:
Matthew Hyneman 421 N SEMINARY ST 26-12-07-203-003.550-028 OLD PLAN 98 PT
PRINCETON IN 47670
Complete and return to: I®IID11EIH fI1 MIIM1ffCII111RUG111111luI�DllTh 1
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 w111I W1 IWII tl11110 II
PARE 2i;'FAYPAYERINFOR,M1AT10N . ,
Owner I First Middle Last
/ ‘A-1-011 E-w Avid Arrotv tiyNr ,,
Matting Address(norther and street.my,state and ZIP code) • I I Same as property address
-
•
Mang Address(punter and street city,state and ZIP code) 1 Same as property address
Social Security Number(last 5 digits) • Driver's UcenselState ID Minter(last 5 digits) stab Other(please specify in Part 4 below)
.PART 3': CERTIFICATION
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she ineligible 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 lia 91e for back taxes - 51;substantial financial penalties.
Owner 1 Signal�re Date
PART 4: ADDITIONAL INFOR,MMATION
FILE "'
NOV - 5 20`112
•
OtB3ON COUNTY AUDITOR
CLAIh9 FOR HOMESTEAD PROPERTY TAX PatM �
CREDIT/STANDARD DEDUCTION HC10
smm wm, s�rs cR� i sos�
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Have a benefidal mterest m the entiry that is liade for Me property taues m the popelty and Cat owns ��12(I��lYO� par9�91a�ra connac�
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I hereby �rtify fhe 2bove is true. m�ect. ard Sigr�ee otA�sor Date sipied
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Vai�Id^B a�lm' Si}�ence dAu�tv Date sgrad
20 _ Pay 20 _
Lesser of 12 Hortiestead
V�uation or 535.000
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