Homestead_Wells STATE FORM 53569(RiB-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.132-8.1
640X '.IMPORTANT NOTICE TO HOMESTEAD PROPERTY;OWNERS x c4
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
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.
s=. PAR I: P'OPER Y INFO'MA ION Tte
Taapaver Name Property Address State Parcel Number Leeal Description:
John R Wells 802 S LINCOLN ST 26-19-19-103-000.546-026 LOWES ADD 29
FT BRANCH IN 47648
Complete and return to: 1111111MINEMMITIMMEIMAIM
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
r47 PART 2: TAXPAYER INFORMATION 1: e
Owner 1 First Middle Last
acyt or)d WeAis tea,
Mailing Address(number L city,state and ZIP cede)
Lv Same as property address
Spouse First Middle Last
On n-1 t • S tke Wells
Mailing Address(number and street,city,state and ZIP code)
Lam[ Same as property address
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 ignanre Date
•
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
S�le Fom, 5173 (R7 � so�
Reabed by tlie Departrrent d Loml Go.�amaY Frwws
INSTRUCTIONS: See raverse side !w filing in�u�ans.
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Veriryirg aakn - Si�e6ve aflwdtQ Dam signed
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20 _ Pay 20 _
Lesser of 12 Homestead
Vadiation or 535,000
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