HomeMy WebLinkAboutHomestead_Burkett . STATE FORM 5356c(53(&40) - .. - 1REAstSFA FORM TS-IA
APPROVED BY STATE BOARD OF.('HINTS.3W PRESCRIBED BY T1E DEPARMEAST OF WEALGO\TA\MEYT FINANCE 117 6.1.1.111.1
.. Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPE RTV OWNERS' ,
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 caue'es higher tax bills for all;therefore,
HFA 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.
.S, .. . . . PART 1: PROPERTYINFORMATION - - ';-* -: '. .- '
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Taxpayer Name Location Address
r _ - Burkett, Andrew B/ _
�/. 307 E BRUMMITT ST
' OWENSVILLE IN 47665
1939 •
IIDIIICIII III II III DM IIIII II III IILIIUIII II D IJDII II Andrew B Burkett DL 0 IIII II II °
307 E Brummitt -
OWENSVILLE IN 47665• °
State Parcel Number . , • Legal Description
� T 26-17-12-202-000.234-022 ' WILSON ENLG 7 PT/14 PT
. . • - JUN 0 72011 � -
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ThI 8MPMMtrSt'4� 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 . . - - .
O' t First , , Middle
Rv� d (2ly -e njotrn n u � jce
Mailing Address(number and street,city.state,and ZIP code) . i D Same as property address
p a `2 oX c�(4 -0---7 .G- 'E,cuyn ni ,1 .4. + S.)-' .
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Spouse First Middle - Last
r.tattu1r:.'auress Number tnd svee4ci—'r-^ .-.j `-_ - Jmuv:u n,;:..:readmsr—c
. g ( ty,STdi.,cold..lY.:WC '�' .. . -_
U M
Social Security Number(last 5 digits) Driver's License/State ID Number (Ian 5 digits) i Other(please specify in Part 4 below)
I I I I . I siza
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 -
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PART 4: ADDITIONAL INFORMATION - - - -
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