Homestead_Hirsch (4) STATE FORM 53569(13!5-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.I-22-8.I
t - IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS'": :- : ` '!
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
!duction becomes more beneficial, there is more incentive than ever 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 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.
• PART!: PROPERTY INFORMATION - bus%+ ithl5F41.
Tawas er Name Property Address Site Parcel Number j.e2a1 Description:
Timothy E Hirsch 252 E 800 S 26-I9-19-204-001.340-026 INDIAN HILLS 100/101
FORT BRANCH IN 47648 pt� p�'i1 IgII f1 II� t�'ID--�27 1p p 1'1 ��11 VV 1nI
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Complete and return to: I8 lli1p1Ilp111110 11111:1111O��E R 0111)11111111131011
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
? l- • . PART 2:TAXPAYER INFORMATIONF ti
Owner I First Middle Last
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T1mo}h nuraoer v9p�c IGSc
Mating Address( and street ciy,state and ZIP code) Same as property aactress
2sa 6 SOU S roc* ergo, IN. Cl7(P ta
First Middle Last
Mating Address(number and street ciy,state and ZIP ode) Same as property address
• Social Sectirity Number(last 5 digits) Drivers License/State ID Number(last 5 digits) State Omer(please specify in Pan a below)
f ;°c• • ,i .. _ , r P• 7`I'3i CERTIFICATIIN:" � _, ° ;. _-. - _,. 13 s-,••
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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Agit,4rci115 ;- a; . -3 Etc s,'. PART-4: ADDITIONAL- INFORMATION
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
S�IeForm5Q3 (R7�s-0�
PieanbeA by iha Depa�trnanl of Laal Goverrmerp Fmmim
INSTRUC710NS: See ieverse side fa filing instructions.
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I heRby certify tlie a6ove's true� mrea� and siBmave of nss�aar Date sipim
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veityinp ectim - s'g�ma orawmr oem signea
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20_Pay20_
Lesser of 12 Homestead
Vehwtian or 535.000 S
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