Homestead_Douglas MINE FOAM.)!M,P_r.V•t nnLASUALR FORM 711A
VrPP'rnev Al-ATE aMRDC. XTPI\7a.`cry PREARn1En BY nit DEPAPINIEVF swtrcAu:ASuittow L FINANCE PC 6-t.1-224.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 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 net 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 art eligible to recei■e the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This information will be kept confidential and can only he accessed by authorized county officials.The t)epanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Douglas, Patrick B
207 S West
Fort Branch IN 476-18
2524
Patrick B Douglas
207 S West St State Parcel Number Leoal Description
FORT BRANCH IN 47648-1343
1r1sr11 rrr�sII ttt�ttII t t�t trrII rrII rr�rr�rr��t��rrr�rrr�rt��t� 26-18-13-403-000.453-026 011-00453-00 PT SW SE 13-3-11 .31 AC
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
Owner I First Middle Last
' ng Address(number and street,city,state,and ZIP code) Same as property address
ao7 S WEST Sr Jz-r 3,e4,vc/f .=.x/ q<767g
Spouse }trst Middle Last
Mailing Address(Number and sweet,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Dtiyas License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
sem
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
PART 4:ADDITIONAL INFORMATION
CIAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
St� Fonn s�q3 (R7 � s�o6)
PreafnbeA by Ihe Deper6rent of Lool Gouermiaq Fsa�
�=NSTRUCTIONS: See ieverse side for /dtirg insbuctions.
FowN �
HC70
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i p,�,e) �� cerur�, a�a� o� aeY a� zo_
i(we) o�w as aa pmaPm aace ot res�ee�� m Aowirg desc�ibed real poperty for whirh a Fiamestr.ad Property�i� ��i d�r�a:
�i �) � � � �g �g �� GIBSON COUN7Y AUDITOR
Have a benefid� mtsrest v� ihe entity Mat is liade for C�e propeny tazes on the property and C�at owns the property or is Wying under a cantracl
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n Gy'eg om m�hacL Fee 5rr�le ownefs rerre
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1 hereby cettify Ihe abwe is true, oomect, and Se�+� o(�r Dam sgied
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20 _ Pay 2(1 _ I
Lesser of 72 Hort�d
Veluation w 535.000 S