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STATE FORM 5VA(R'J4.9) TREASURER FORM TS-IA1
APPROVED B'STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1 22-B.I
E IMPORTANT NOTICE TOMOMESTEAD PROPERTYOWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
0 `Iuction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
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auses higher tax bills for all; therefore, HEA 1344-2099 requires taxpayers who receive the homestead
s • ndard deduction to verify that they are eligible to receive the.benefit and to provide additional identifying
information necessary to allow county government to better iridnitor.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 co'unty.officials.eliminate
- homestead fraud. • - '
PAR -I: P'OPER YIN O'MA ION .
Tasnarer Name Property Address Stale Parcel Number Leal Description:
506 S Cumberland
Larry F/Janet Georges 26-18-24-202-000.251-026 011-00251-00 LOEFFLERS ADD
Fort Branch DI 47648 ✓ 1/2/3/4
Complete and return to: _
- — GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2:TAXPAYER INFORMATION • -
Amer I First Middle Last
L a r r 5' r
Mailing Address(number and street.city.state and ZIP Code)
� U
L I Same as property address
s a6 s. l_' ✓m 6V-r ian(/ Ft -.2 rrant,'J. • r, 4/76.fF - :. .
•
Janet l.. 6PCit-fie ,
Mang Address(number and street.city.slate and ZIP code) i'�same as property address
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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 Signature Date
gp„,, / oy. j � S_ 6 - / o
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PAR'F4:.ADDI'1'IONALL\FORMATION -
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CUlll�i FOR fIG���iF�l� P{1�PER1'f Tl� Cf'�IT FOr 1'CA�R 19�
S[E BACK FOR FILlt•!G IhlSTRUCTIOi•!S
Z,,'•,,:e) OI G/�-t.t ��Gr+.n4✓ certify that on tti� 1=t dal c�
�;��� lg � I� (p� of-�iEx3 as Q�ur princioal olace of residen� tt�e folloaing dscrikpd real
��i _, �rty for �•.hich a Flmrnst._ad DroF�. rty Tax �edit is h�rel�y b°.ing clai�red:
I, R;?, � o:;�a� � d/�- DD� ��-oo
� are bu; incl urrl°_r cbntract'
� hace a b��°ficial int st iii th° ta.��ayer
Frecrrty P=SCrip�ion in _
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Pe_rC�l ilt�d.�� I
I- bu.ino on �ntract: Gwn�rs i�r� (�°_
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or 1 al des¢intion s}rrwn on tar, stat�irlit:
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Contract r�orci�i in P°mrcl_r's Ofiice - P°card ib.
Paae
I` ��y cortion of �ie residential stn:cture or �]ie land, not e��e��ing one (1) acre ttiat
imr�diately sunrourcis that structure is usecl to procauce incarw_, descrii� t}�e use arr3 cortien o:
tne nroe�sty utilized ,`_o p�^3u� ir�orre
��n}� o��°r wutlties in r:hi.ch incli�zdual c.:ru or is bvl�ing real pro�sty: �untv
,�s�1��� c�-; ify the ab�w_ u�temnt is true c�rre�t arri cor�lete.
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prop°-rty �itis oii :��_ resid��ce, or has a Lp.n_ficial int�rest in t}�° tar.wYer.
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