Homestead_Douglas (2)I
STATE FORM 53569(R3r5-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.I-22-8.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS w...
Individuals and married couples are limited to one homestead standard deduction. As the receipt of tills
deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud •
•auses 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 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. 7
. PARTI: PROPERTY.INFO'MATION • ' 11
Taxpayer Name Property Address State Parcel Number Leant Description:
Bob Douglas 416 N MAIN ST 26-17-01-404-000.325-022 SMITH ADD 3 PT
OWENSVILLE IN 47665
Complete and return to: _ 1mII DLUlllIlllII1!fEWUhIIAUhIUll;1fIIEIR/OMB
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 W fu
PART.2: TAXPAYER INFORMATION
Owner 1 First Middle Last
-
0/my - - csaS
Wiring Address(number and street.cry.state and ZIP code) I Sarre as property address a /L/, _rte 59-74G
.
Sp.. se First IL Saddle Last
/-I�vN IL 2,481 i' G—t4 S
Mang Address(number and skeet.city.state and ZIP code)
J Same as property address
ier 34/7 1,0(2//tC, .X— 4114 6S-
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: ' lure Date
art.
- / P ART 4: ADDITIONAL INFORMATION �, -g
I -- . W l / �E D
NOV 7 2017
GIBSON COUNTY AUDITOR