Homestead_Conway (2) STATE FORM 53569(R3/8-10) TREASURER FORM TS-IA
APPROVED By STATE BOARD OF ACCOUNTS.20119 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 106-I.1-22-311
IMPORTANT:NOTICE:TO HOMESTEAD.PROPERTY OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
,,,-Individuals
becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
uses 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.
' --- PAR 1: PROPERTY ENFORNIATION
Taapamr Name Property Address State Parcel Number Leal Description:
Danny L Memmer 410 N GIBSON ST 26-12-07-203-001.602-028 OLD PLAN 80 PT
PRINCETON IN 47670 pp11 IpI fm11 11pp�� mmopopt1 fB
Complete and return to: I®hID11J0�0 EINE1Qlm®Il'dHJDDWmIIMO
• GIBSON COUNTY AUDITOR- 101 N MAIN PRINCETON IN 47670
. PART 2. TAXPAYER INFORMATION
•Owner I First Middle Last
( P itSfp JUJia 60 Oa/ .
Wiling Address(nutter and street.city.state and ZIP code) / s/1�/,{/��s / // -
Lit() N. 6-1bs IM 5-1-. P/i/ a r// 'y TA �.I `j0 address
_
Spouse First - Middle last
JO5klAa- Aact do' nw
Maifug Address(nurtter and street dty.slate and ZIP code) ume as property address
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 Signature Date
-' PART 4:ADDITIONAL INFORMATION -- -
• _ _ ._. LL'f - .. . _ .
GIBSON COUNR •
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