Homestead_Staback STATE I ORMI!!w l R:/v.Ni TREASII EER FORM 79-IA
APPROVED BY STATE Nv oOf Mfl .T.IDs Pt1YRIara BYt11EDEPARTn:YT IL'flat fOVERYMnrr FINANCE IC 4-1.1-224.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead siandald deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than eser for homestead fraud.homestead fraud causes higher lac bills for all:therefore.
® HEA 1344-21109 requites taxpayers who receive the homestead standard deduction to verify that they am eligible to recehe the
benefit and to provide additional identifying information necesoly to allow county government to better monitor homestead
fling..This infornution will he 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 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Staback, Patrick C/Kimberly A
103 Sa Campbell HIND
Ilaubstadi IN 47639-S 162
7274
Patrick C/Kimberly A Staback
103 Campbell Blvd State Parcel Number Legal Description
Haubstadt IN 47639
26-18-36-401-000.618-009 013-00618-00 WEST HGTS 4TH ADD 13
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
JA7rdic.K C . c K
g Address(number and street;city.state,and ZIP code) Er Same as property address- .-
/03 S. CnmpogLL (3/uo Hauj25Trm; J1IV 2-17b33
Spouse - First Middle Last
KIn►13ER< 19. ST,gr -cK
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
203 S' Campbell Sivo Nqubsfierri 27v tlA37
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 eliuible 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 gna Date
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•
a • PART 4:ADDITIONAL INFORMATION
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