Homestead_Weber STATE FORM 53500(RJ/610) TKOS' MLR FORM'MIA
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' �'� PFRO'YFD BY STATE BOARD OF ACCOUNTS X09 PRF_YRIBFD BY TUE DFYARMET OF LOCALGOVERMEYT MIA`[E M61.1-'34.1
• 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 tax bills for all;therefore,
• HFA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
T � / fit and to orm'iti additional identifying confidential in(ortnd ca necessary to allow county ized count oto fficials.better monitor homestead
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ngs.This information will be kept confidential and can only be accessed by autAorized county otTidals.The DeparDnrnt of
)� I Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
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PART 1: PROPERTY INFORMATION
R IS �n�1 . Taxpayer Name Location Address
C.J.IV Weber, Randy - .
. 2166 W 1300 5 RD
GIBSON COUNTY AUDITOR /^` HAUBSTADT IN 47639
2952 IIII IIII IIII• , IIII III ��II IIII III II II
Randy Weber II_I uI I I.Oil 1 1111 I III OIu 1111111 lI�II 011011:11111 l.l_I II I_II�X1101101010 llllll
2166 W 1300 S
HAUBSTADT IN 47639-8667
II111I1iI'III'IIII'1IIIIIIII III'I"III'IIIIIIIIIIttI11tIIIlIIIIII State Parcel Number • .. Legal Description
26-22-14-300-000.480-024/PT SW 14 4 11 .62 AC D-2
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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.
j • PART 2:TAXPAYER INFORMATION
Owner t First Middle Last
I�o.ncii }Cal e, Weber. -
Mailing Address(nt�mbcr and street,city.state,and ZIP code) - Same as property address ..
. -
Spouse First Middle - Last
Mailing Address(Nwnbeiand streeC city;state,and ZIP earn). -.. Brine as property.address-__— - _ —
Social Security Number(last 5 digits) Drivels License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
I I I I I I I I , I .°
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 Date