Homestead_Arrick I
STATE TO21.159569(R1 17d93 TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ALTDIMS,1DM PRESCRIBED BY TILE DEPARTMENT OF LOCAL GOVFRI.MEN!FlNAME IC 6-1.1-22 8.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes 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 benefit and to provide
additional indentifying 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.
PART 1: PROPERTY INFORMATION
Property Address(number and street,c' ,state,and code)
State Parcel Number
‘,26 - / d - o7 - Nor - 000. gL37-o6-8
.
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
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Mailing Address(number and street,city,state,and ZIP code) I 'c rte as property address
Spouse First Middle Last
I Mailing Address(Number and street,city,state,and ZIP code) 0 Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
State
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
Spouse Signature Date Telephone
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' PART 4: ADDITIONAL INFORMATION
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An 2 8 ?DM
• INSTRUCTIONS