Homestead_Sullivan (9) •
STATE FORM 5359900/S-10) TREASLREIt FORM TS-IA
APPROVED BY STATE RfMRO OF ACCOUNTS.?LW PRECRIRF➢BY THE OPARTMEVT OF LOCAL GOVERNME T FINANCE IC 6-1.142AA
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
Princeton,IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher taz bills for all;therefore,
HEA 1 344-2009 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.
PART l: PROPERTY INFORMATION
Taxpayer Name Location Address
Sullivan, Leslie
705 W Broadway
Princeton IN 47670
811 -
•
Leslie Sullivan
1111oiH_HimilHI/0011_IIDIIIIDil101011011_11U111111110II 100110111101111101111
705 W Broadway
Princeton IN 47670-2009
I'IIIIIIIIIIIIIIIt1hIIIlIIIIIII'IIIIIII'II'IIIIIIIIIII'I"'DPI' . State Parcel Number Legal Description
26-12-07-301-001.018-02/PT SW 7-2-10 .09 AC
•
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment-to the county treasurer.
• PART 2: TAXPAYER INFORMATION
Ov... . I First Middle Last
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Mailing Address(number and street.city,state,and ZIP code)" j 76 7 a .. ® Same-as property address
70 S 2.t.i 2 13 resat 7�[ Idr.�-
' Spouse First • Middle • Last
MartmAddfil(':umberanc street,city;stareralm/A'.;.,de)-. - -.__ -- - - - - - 0-Sameaspwpnryaddr. _ ,. - - _ .
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in.Part 4 below)
I I I 1 Sbut
• - 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 I Signature p Date