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STATE FJILN 53569(R2/BA9) - TREASURER FORM TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED By THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 106-I.1-22-E.1
* IMPORTANT NOTICE'TOAOMESTEAD PROPERTY-OWNERS -
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
fiction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
uses higher tax bills for all; therefore, HEA 1344-2099 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.
raR1I ROPER fl INFOILIIATION
Taspaver Name Property Address State Parcel Number Legal Description:
Odessa Winds Inc R 1 Box 162 009-00432-00 PT LOC 125 1-10
Patoka RI 47666 2132 AC C-I
•
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2:.TAXPAYER h FORi\IATION
Owner 1 First Middle Last
Qoss t Ma.rfiri Ey
Wang g Address(nutter. ; eel.aty,state and ZIP code)
-r7 Sane as property 4 dr l(c per ades
s3a9 Ni 552 _ PA-- ; ITN s
cP
,�
Spade First Middle Lass
Shin no ri
Mailing Address(nutter and steeL city.state and ZIP code) Same as
property address
),c7 IV 57) Pte; K_CA (1—. 1K( �i 7
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:ADDI PIONAL:INFOR:Mt:4TIO,N
FILr,D
MAY 2 4 Lulu -
GIBSON CO
GIBB COUNTY OITU"