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SUTE FORM 53560 DU/&10) TREASURER FORM TS-/A
APPROVED RV STATE POAR,OF ACCOUNTS.PA PRESCRIBED RETIE OEPARTME'r OF LOCAL GOVERNMENT FINANC IC 6-1.1,224.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY ON'\°ERS 12 '
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
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 byt authorized county officials.The Dcparunent of•• Local Government Finance will use this information to create tools thai will help county officials eliminate homestead fraud
PART 1: PROPERTY INFORMATION •
APR 6 2011 Taxpayer Name Location Address -
�y Baker, James S III/Corellen • -
'201 N SCOTT
GIBSON COUNTY AUDITOR .. , OWENSVILLE IN 47665
205U
James S III!Corellen Baker III I II1uIII_11III[II IV[1111l_ II III VIII 1 III II1III1I11II 1111111 11111 111 lIV ll
201 N Scott ST
Owensville IN 47665-8762 ,
1111111III411 1111111'1111111111 11111111111"1111111111'1III 1" . State Parcel Number Legal Description
26-18-07-101-000.024-022 / PT NW 7-3-11 .15 AC SCOTT
. ' / ENLG2PT
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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 -
Ov I First Middle , '
• Last
-/.�mff5 ; r Lt )4-Gf-uit_ L
Mailing Address(number and street,city,state,and ZIP code) - ❑ Same as property address
2d( N 5 c_07"Y ST. CL JU5c3 (-Cs- - zv r ?16 5-
•
Spouse First) Middle • Last
htailin Address umber and street,ci state,and ZIP Cade -'- ----”-- -- -— `u-Same as�1 adds
•
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
I I I I I I I I I 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 Telephone
III ignature / //C Date- Telephone ( ) 1 ...
l
PART 4: ADDITIONAL INFORMATION