Homestead_Black (2) chit FORM!Mt.lF'ra4Mt TREASuRA FORMStA
IMPORTANT?NOTICE TO DEPARTMEVT OF LOCAL
PROPERTY OWNERS
Gibson County Auditor
101 N Main
PRINCETON IN 47670 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 escr 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 creche the
benefit arsi to provide additional identifying informatmn necessary to allow county government to better monitor homestead
Mims,.This information will he Lim confidential and can only he accessed by anthnrired county officials.The Depanomt of
local Government finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Black,Jeffrey R/R Star
204 F Mill
Patoka IN 47666
479
Jeffrey R IS Star Black
Po Box 251 State Parcel Number Legal Description
Patoka IN 47666-0251
II III II II II
r n ru r ru ur a 26-04-24-300-000.448-020 018-00448-00 FISHERS ENLG 1ST
unr
6PT/14PT
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
n:Address(numner and street,city,sate,and ZIP code) - G Snore as property add: ; - - -— — — -
P. O. BoX 2.5 I IATOKA id 41 c.4f
> )
Spouse First Middle Last
2, Si 2 3L4CC
Mailing Address(Number and street,city,state,and ZIP code) fl Same as property address
e.d . /Sog 261 PATot-sA r IA! 1LLG
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
PART 4:ADDITIONAL INFORMATION
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