Homestead_Haynes STATE FORM'1S69(R3'&10) •1 ' TREASURER FORM TS-IA
APPROVED Bi STATE BOARD OF ACCOUNTS.200.3 PRESCRIBED BY THE DEPARFMEAT OF LOC.ALOO'ERNMENT FINANCE IC 61.t-118.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes'
Princeton,IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore,
HEA 1344-2009 inquires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
,• filingst and to provide additional identifying confidential tial and ca necessary to allow authorized government oto fficials.better monitor homestead
of
filings.This information will be kept confidential and can only be accessed by atahoriztd county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
APR 5 2011 Taxpayer Name Location Address
Haynes, Phillip L Jr/Dawn R Byers '
- t \ �v\ 706 E EISENHOWER LN
GIBSON COUNTY AUDITOR - HAUBSTADT IN 47639
2781
Phillip L Haynes Jr. II�I�I�II.0111 DII I.�IIII_I_I QIII �I�III�I�II�II_II_IIIII I�I_II�IIII0lUIi EUli II
706 E Eisenhower LN
HAUBSTADT IN 47639-8034
I1III'I' 'll'lll'llll111'llli iIIIitlttll"IItttllll'llll'iIll"II State Parcel Number Legal Description
26-19-32-101-000.247-024/ MACK CURTIS 9
•
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
Ov. . 1 First . Middle Last
•
Pklrif ' Lee N4,(1 4 e Sr,
Mailing Address(nurn and street city,state,and ZIP code) /1 // ame as property s
1,6 b le e 1rse hotorr: —4-ne N a kcig rile Xi/✓ 1 y�6.3%_
Spout irst - Middle .. • . Last
4.CO� g e nee Pones •
--- Mailing Address I c u m i b e r and street;city.svte;and Z I P 'r .__, _ mC ai property a.cess - - .
_.
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
CLAIM FOR HOMESTEAD PROPERTYTAX
CREDIT/STANDARD DEDUCTtON
Stata Fortn 5/73 (R614-03)
Prasaibed by the Department of Loral Govemment Finance
INSTRUCTIONS: See 2verse side lor (ling insfiictions.
�
� �e) L� �f' rt��
I(Wej occupied as our prin �pal place o( residence the f wing describ real property (or which a Homestead
❑ I(We) owned ❑ Are buying under wntracl
� Have a benefidal interest in ihe enfity that is liable (or ihe property taxes on the property and thal owns the {
If buying on conUact, Fee Simple ownefs name
wntrad is recorded
FORM � YEAR _
HC10
�stQlay oLN��ch, 20_
ty Tac Credit is hereby daimed:
O�OUN� n� �act.
Record number � Page
CwnN Tawnship Tacing tlistrict (ury, fo , tow ")
Parcel � �� /'^ al n Is ihe m
' W/ p pe i estion:
� al m
P perty ❑ Mobila Homo (/.C. 67.1-7)
If any poM1ion ol Ne resitlantial sWcWre or the Wnd not exce ing one (i) ave that immeEiatey rtounds that swcEUre is used to protluce income, describe Ne use and poNon
ot Ihe pm rty uWizeO to produce income.
�ILt�P�d�-i4-.�a-�o�-_�.a�� 0��:.
ravnsnip
I hereby certify the above statements are We, coneG and complete.
aM sheet ciry;
Counry
af
Twvnship
20_Pay20_
Lesser M 1Y2 Homestead
vaivanon w 535.000
�
Date sigr�� ^ ]�O
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