Homestead_Dillon�,. ..,,.
,� t CLAIM FOR HOMESTEAD PROPERTY TAX
ir ,� CREDIT/STANDARD DEDUCTION
�; State Fortn Sa73 (R2 / 5-92)
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INSTRUCTIONS: See reverse side !or �ling inshuIXions.
FORM YEAH
HC70
il ' H � I� �
. °; . . `-.,_ -.-. . . � "�'CERTiFiCAT10N STATEMENT:_. �. -• , •_-- . ., ... -
_.� -_ ' .r�v' n n."�nOSl
(� (1f1 ��/Vv
I(We) _� i1 ¢ �� V V PYV� . � � certity that on [he 1 s[ day of March„79_
�e) occupied as our principal place of residence the tollowing described real property for which a Homestead Property Tj Credit is he e j�� J
I(VJe) owned ❑ Are buying under contract ��"~� f�' IT�! �•��L
.- _...,`• .
❑ Have a beneficial inierest in the entiry that is liable for the property taxes on ihe property and that owns ihe property or is buying under a contraa.
... ., .� . _ . . . . . CONTRACT RECORDED _,- _ ... . .. , _ �� .. � .. _ ` . , .. �, ,. .° �.F..
If buying om m�irac6 Fee Simple owner's name � ..
Rewrder's ottice where wniract is recorded Record numher Page
� � PROPEHTY DESCPIPTION � � - � - �" � ' " � ' " �
Counry Township Tasir istrict (ciry, fown, rownship)
Parcel number Legal description
_ �, � 3-z- a8.
If any portion of the resi0ential structure or the land not ezceeding one (7) acre that immediately surrounds ihat slrucNre is used to produce income, describe the use and ponion
of ihe pmperry utilizetl to protluce income.
- - � ASSESSOR USE ONLV �UE TAX ASSESSED HOMESTEAD NON-RESIOENTIAL`. �.
. . �- VALUE � VALUE VALUE . VALUE - .�
Land noi exceeding 1(one) acre immediately - .. �- �_
surrounding residential improvements. (�) � �
Other iand (p) ''' ��'
Total land (line 7 plus line Z� (3)
Dwelling (4) � ..-
Residential impmvements - - �
Gara9e (5) . ' ' .
Other improvements (6) �
Total improvements (line 4 through line � (7�
7otal value (line 3 pbs line � (g)
I hereby ceRity the above i5 Irue, rArrect, and Sgnamre of Assessor Date signed
complete.
Verifying aaion � Signature of Audimr Date signed
.�
� - . STANDARD DEDUCTION ALLOWANCE' . � �
79_Pay19_
Lesser of 7/2 Homestead
Valuation or $2,000 �
5 Wre of AuEit r Date siqned rX,
5 � � I � V
SfATE FOR.\f 53YA(R'JS-09)
MPROVED BY SfATE BOARD OF ACfOU\T5, 2009
PRESCR�ED Bl' TNE DEPMi1.fEYi
Indi��iduals and married couples are limited to one homestead standard deduction. As the re
�d duction becomes more beueficial, there is more inceuti��e than ever for homestead fraud. Hoi
auses higher tac bills for all; therefore, HEA 134�1-2099 requires taspayers who receive the
standard deduction to verify that they are eligible to recei��e the benefit aud to provide additio�
information necessary to allow counh� government to better monitor homestead filings. This
���ill be kept confidential aud can on11' be accessed by authorized county officials. The Departn
Government Finauce will use this informatioo to create tools that will help count�� officials
homestead fraud.
. . - nyv�� ru.rn�r�-,�:�Ker� � . ��4:rr� - . .. ...
Tacwrer\ame /
!
Dale G Dillon \
Coniplete and return !o:
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o�„� i
�T�G G
MaimB AOOress (munCx a(W sVeet. titY. stata �
S"'y r N
Social SecuCy Mmber Qut 5 mgitt)
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Mbale
❑ Same es properry aee(ess
i
n�su�e Fox..+rs�,+�
iT7 FIN,NCE K61.IQ2-8.1
f .. .
�
eipt of this
iestead fraud
identifying
of Local
006-01621-00 P} S SW & PT S SE i
? 1128.16AC �
f�/LG o'w
$o�l Seaa2y AhanEer (lsst 5 Ngits) Ome/s L�ue Sta'a ID NumEU (lazt 5 Ei91n) Sse p� (pyase spxyy n
��� m
" � 4•. � �'�a��
Each undersigned�certifies, under penalty of perjury, that the above and foregoing information is true and cortect and that he or she is
homestead standard dedudion on this property. Each undersigned also understands that, by Gaiming additional homestead deduGioi
she may be liable for back taxes and substantial financial penalties.
o»�. � s�ive oa.e tei�b
'�-%ri '"'� ` I ' / � �'_ � d
SCana
LUIU
GIBSON
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