Homestead_Miskell (9) STATE FORM 51564(R1 l 749) TREASURER FORM TS-IA
APPROVED BY STATE WARMS.ARDUNTS.2C09 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT[NANCE IC 61.1 22/I
IMPORTANT NOTICE 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 causes 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 indentifying 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.
PART I: PROPERTY INFORMATION
Property Address(number and street,city,state,and ZIP code)
as �- e,n.-uoe,y, R ,
State Parcel Number
aria-o'7- Z4 - 003 5 a9 i-oaf'
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
D . „
Mailing Address(number and street,city,state,and ZIP code) 0 Same as property address
'
Spouse First - Middle pp t
•
SEP Mailing Address(Number and street, state,and ZIP code) ❑ Same as ro address
1 D -
G 1 t)', ) P Pent
/.., .
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 heft' ON COUNTY AUDITO
Suit
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 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 II SSiignature� t Date
INSTRUCTIONS
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�J, 1V1\ nS�[E^UIIi�,CK IFOR FILItJG lidSTRUCTIOidS 'yy
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,�•,,re) 0�'C' ��+�� certify that on ie st al c.
�4ch, 1' , I, (Pi=) ecc�iea as our princioal olace o� residen� t��e.follaaing described real ;
rom_� ty � cr ��;hicn a I?�r„�ste�3 ?ro{7'-rty Tax Credit is 1i�seUy L�,ing clai��rxl:. ;
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. D s�x_c� (C�ty, am, 7b;Y;isluo) : - - - - -
L1�„� :iw�,�,- I I or legal description s}��m on tax statom�t: ':
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- - �o::uact r�ord� in Pec�rder's O�fice - P�cord ib. Page
'� �;�v �:-uon oi ti�_ resitistial s�rt:cture or t]�e land, not e�e�iit�g one (1) acre t�iat
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i il^_T°1�\' C�•.`1:i L.rl' �� l�"O S:c7��CG'71ti. 1S tS112� NLT2�'t c17L� CJIi`�1°-t°• i
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o,-o��-cy ;.axs on tl�_ resid��ce, or tias a L�en_Ficial intesest ii� t1i_ tar.Ea�Yer.
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