Homestead_Warren (2) STATE FORM 53569(R3/8.10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 106-I.1-22-8.1
1 IMPORTANT NOTICE-TO HOMESTEAD PROPERTY OWNERS'
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Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
eduction 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
s andard 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. .
PAR'fl PROPE• l'I\FORMA • O\ .
Taxpayer Name Property Address State Parcel Number Legal Description:
Jackie L/Stephanie D 203 E MONTGOMERY ST 26-17-12-202-000.490-022 OLD PLAN 44 PT PT
Warren Jr Jr.
OWENSVILLE IN 47885 NE 12-3-12.1308 AC
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Complete and return to: I®hIDll]lIIQ1mlu]03�1mEJI U UmU]mmm0]lll®
' -GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
7111 .I
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PART'?: TAXPAYER INFORMATION
Owner I First Middle Last
(TAC-K Lynn • Wan-4-N-)
Mating Address(number and street thy,state and ZIP code)
Same as property address
1.D. (3 e x (Q-mss rasu, k l.e ,T ci-')'(C
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First Middle Last
Mating Address(number and street thy.state and ZIP code)
I Sarin as property address
P:O . l pX (035 /. flL -sv;) 1tX11 Lit5(c, oS
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PART 3: CERTIFICATION
Each undersigned certifies,under penalty of perjury,that the above and foregoing-information is true and.corect and that he or sheds 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 Signature Date Telephone
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- PART 4:ADDITIONAL INFORMATION . .
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