HomeMy WebLinkAboutHomestead_Davis (2) - - STATE FORM 5356 (P3/&10) ISEASUAFR FORM TS-IA
APPROVED BY STATE B05Rn OF ACCOUNTS.3C0 PBESCRIBID BY THE DEPARTMENT OF LOCAL GOVFRNMEYT FINANCE IC 61.1-33$.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,
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
• �' p q benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
eL� filings.T is information will be kept confidential and can only be accessed by authorizeed 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
APR 11 2011
Taxpayer Name Location Address
C. .ny Davis, Willie Lee
v �V\ 0 WOOD STREET
GIBSON COUNTY AUDITOR
PATOKA IN 47666
5S6 '
Willie Lee Davis II ItIII]DIIlII�II IIIvII I- III [I III I II II_II_III I I 1 II0110u11�1 ii 1111111
PO Box 57
Patoka IN 47666-0057
IllIr III'1111'lIIlIlIllllttrIIllrl"II"Illlllll'1Illll1ltlrltrlt State Parcel Number Legal Description
26-04-25-101-000.240-020 / BARNES ENLG 67PT
_0
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
• .._ I - First Middle Last
Li)/ /Li, l - L. g c l�a i i c
Mailing Address(number and street,city,state,and ZIP code) Iii/game as property address
321Wn0JcT P.nz3e7x .5"9 0,4-M A7,4 z-/ /-./-, 4,
Last
Mailing Address(Number and street,,�e,and ZIP code) in Same as property address
Social Security Number(last 5 digits) H License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
i t I state
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 1 Signature Date
O . z �f. , /l//24i/
Signature --- Date Telephone l
) _-
PART 4: ADDITIONAL INFORMATION