Homestead_Doerner (3) • [IATE HAM nN.ir I•-e0 TREASUIER FORM 15-1A
• APPROVED BY AVE BMRDI*MYI'.N1'2I'n PltralUBm BY nil DEPARTMENT OF LOCAL COITLNMT7 FINANCE IC 6-1.1-2:4-1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individual and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive dun ewer for homestead fraud.Homestead fraud causes higher tae bills for all;therefore.
• HEA 1344-2009 requires taapayen who remise the hanestead standard deduction to verify slut they are eligible to receive the
benefit and 10 provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he dpi confidential and can only he accessed by authorized roomy officials.The Ikpanmem of
Local Government Finance will we this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Doemer, Keith Eugene/Freddie C
202 Jefferson
Somerville IN 47683
8468
Keith Eugene/Freddie C Doerner
P O Box 328 State Parcel Number Legal Description
Somerville IN 47683-0328
Itlnllnrll11u1u1iu11i11 Ilu tltllu1ni1i11u1i1i1n1 26-20-02-404-000.058-003 020-00058-00 RADAR ADD 3/4/5
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
iei -/4 t141 e4e Doernev
-- One Address(number and street,city,state,and ZIP code) — /- — - — ------ ❑ Samc ac pf5pem i ano -- - -- - - -
Box 32-8 So- erv) / le , ' -ldlg he- Y76K3
Spouse First Middle Last
Mailing Address(Number and street,city,state.and ZIP code) 0 Same as property address
Social Security Number(last 5 digits) DrisxYS License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
she
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.
Owns I Sitm� V/`V Date '
Spouse Sltmam,re Date Telephone r l
PART 4:ADDITIONAL INFORMATION
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