Homestead_Burchell • STATE FORM 53560(R}/610) TRFASLTOA FORM T5-IA
APPROVED BY STATE BOARD OF ACCOUNTS,209 PRESCRIBIDBY THE mYARTME\T OF LOCAL GOVERNMENT FINANCE IC 6-1.1.214.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
�y1011r N. Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
�r 1,6_ more beneficial,there is more incentive than ever for homestead(mud.Homestead fraud causes higher tax bills for all;therefore,
1pu, 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
1 6 V 2011 Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud
NOV Y PART 1: PROPERTY INFORMATION
c.�.f+ "
Taxpayer Name Location Address
GIBBON COUNTY AUDITOR Burchell, Larry L/Susan C/Kimberly S
Per
W WARRICK ST
OWENSVILLE IN 47665
6275
Larry L Burchell . `. IIIJElIll BIIIIEIf!II 0111 _IlEl DIIIE Ill/I lII i II_IllElI Iii IB II[II]1111EILEI III
P O Box 496 -
OWENSVILLE IN 47665-0496
1111+1111111111111111.11111111111111111111111111'11111111111111 State Parcel Number Legal Description
• 26-17-12-201-000.157-022 WAR 2ND ADD 32 PT
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.
- - �.__. ____ ___,__�_.__-_ __P ART 2: TAXPAYER INFORMATION
E LLd9 kc-e,C First 'Middle Last
•K:Imbe rte{ Soe akin l r
Mailing Address(Number and stmt,city,state,and ZIP code) ❑ Same as property s
1 aq. S • E4C5,6ta`&1., F(I CUN g 1ft ec J a `177k1
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 l tore die //� /r�/�j/�'/ Telephone (14 ) 7�e s z
S /C/`� pyre I Telephone �1 /,,//��/• Y`!/�
/,r J.
�/y i / s ///17 •�Dg./-r (g671-) EXIY / �'v7 D
[�' PART 4: ADDITIONAL INFORMATION - .
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