Homestead_Williams (10) STATE FOAM$is69(RE/1A9) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,10)9 PRESCRIBED BY THE DEPARTMENT Cr LOCAL GOVERNMENT FCUNCE C 6.1.1-214.I
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 I: PROPERTY INFORMATION
Property Address(number and street,city,state,and ZIP code)
9 c '- 505 kiQ Qt1 I �
State Parcel Number
z LAS - 35 ace) Poo o5N - co (a
FILED
NOV 6 2014
PART 2:TAXPAYER INFORMATION
Owner I First Middle
. �(g QN COUNTY AUDITOR
Rob er�' LiJ\ �1momS
Mailing Address(number and street,city,state,and ZIP code) Same as property address
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) [] 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)
Sus
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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 ignature Date
( )
PART 4:ADDATIONAL INFORMATION
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INSTRUCTIONS