HomeMy WebLinkAboutHomestead_Medina STATE FOILM 53569(RJ1,.10) TREASURER FORM TS-IA
APPPOVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF Ifn'-t GOVERNMENT FLNANCE IC6-1.I-22-5.1
IMPORTANT:NTOTICE TO HOMESTEAD PROPERTY 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
buses 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.
- PARTIi PROPFRTY INFORMATION..
Taxpayer Name Property Address State Parcel Number Leeal Description:
Carmelo S Medina 709 S GIBSON ST 26-12-07-403-001.515-028 SMITH ADD 2 PT
PRINCETON IN 47670 0gI�Ip� pf�0
Complete and return to: I®11007lf 0 001®IW W ftlm110W Dint REMB��®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 1Il
P#. ''- ., 'f r r ANT..'.T Xi AI'ER'L\F,OR:%IATION
Omer 1 First Middle • last
•
Mailing Address(number and street,city,state and ZIP cede) T�,1 7 'f µ,/
767 R GIBSON PR i N c& N, I IV t 7,670 l I Same as property address
• First Middle Last
Mating Address(number and street,My,state and ZIP cede) Sane as pmeert,address
Social Security Number(last 5 digits) Drivers Iicense/State ID Number(last 5 digits) slate Other(please specify in Part 4 below)
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 1 Signature Date
PART 4:ADDITIONAGINFORMATION• ;
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