Homestead_Clevenger (4) STATE FORM 53569(RNS.10) TREASURER FORM TS-IA
AQPROVED Be STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNNMENT FINANCE IC6.1.1-12-8.1
• - 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
•auses 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 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.
PART1: PROPERTY INFORMATION
Taxpayer Name Property Address State Parcel Number Leal Description:
601 WOODBREE I ST /
Brenton Clevenger 26-17-I2-101-000.209-022 WOODBREE ADD 3 N' -V/
OENSVIL SVILLE IN 47665
Complete and return to: IIIIIIIUn7DfHImllDll]MEMIHJUDDI II ImD7lllllll
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON WIN 47670
J ll� IY Wlll I WI
PART 2: TAXPAYER INFORMATION -
Owner 1 First 1 Middle e 9 Last e_ven3 cr.
Mailing Address(meter and street,city,state and ZIP cede) I �''Same as popery address
101 u9oe3clbree S-}-• Out ».Sv1I te)) X13 ' 9'7 /A �
,
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 1 Signatur Date
- •
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GIBSON COUNTY AUDITOR