HomeMy WebLinkAboutHomestead_Harrison" CLAIM FOR HOMESTEAD PROPERTY TAX �� '\ FORM YEAR
CREDIT/STANDARD DEDUCTION ''j ,^'J
SlaleFortn5473(R8/7-07) �i 1'��, HC10
� ,. � Prascnbed by the Deparlmem of �ocal Govemment Finance
INSTRUCTIONS: See revarse side /or filiig insLuctions.
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I(We) � certify ihat on the 1 stydyaoy�uf' Mar�ch, 20
1(We) occupied as our prindpal piace of residence the tWbvring described real property fw which a Homestead Property Tac Cr&diY��n�reay�ed:
U
�(We)avned ❑ Are buying underantraU GIBSON COUNTY AUDITOR
.� Have a benefidal interest in ihe entity that is liable fw the property tazes on the property and that wms the property or is buying under a contrad.
If 6uym8 on oonVa0. Fee Simple awnefs rmme
Recadefa office whera conVad is recortlad
Counry TamsNp
Paicd number � Legal descnpGon � Is the property ui
Record numbei � Page
� � /�T� ProPertY ❑ Mobile Home (IC 6-7. f-7)
If arry portion of Ihe residential structure or the Wnd nol �ceedirg orre (1) acre ihat immediately wrtounds Uiat siructure is usetl la produce Ncome. describa iha use aM portion
of Ihe property ulifized tn produce incwne.
a�-�a-��-3c�-c�i. y��-�a7
,. . . . .. . ,
„..
. _ _ _._,....
Land not exceedirg 1(one) aae immediatety (� � .. �°, -.
surtounding residential improvements. , r' -
,�-,
OMer land (Z� .
Tdal land (line 1 pfusline 2) �3)
,^..r ? '.y r r ` . .
Dwellin 4 T ' t�"� *x �..' .. .
9 ( ) Jr , R aYa-�+ "+-sf,. ..�^ ;>
Residential improvements or Mnually � s.'f+_5t�� '�� �!.. ,.- r
Assessed MoG7e/ Manufach�red Home Gara e �' '� `G '�'�' .5,�'�':=i•^ "�s �:
9 �5) '..T�'A` ��"`•t'•r.�!�::t��=;•-�;�,'��'2f:�:
4..<.,s.av, Ft'.;h.
s .�ij,q<rt�a,`;
Other improvements (6) . „
.-., .:;t,�°�;
Tctal improvements (line 4 fhrough Grre 6) �7�
TUaI value (line 3 plls Gne n (8)
I hereby certify �he above is true, careCt, and SignaWre ofASSessor Date signetl (monN, day, year)
complete.
Veifying ac4on - SiprvWre of Audibr Date signed (mm(h. OaY. Y�
� �.-� � � • •
20 pay 20 _ qs.ppp {pr 2007 pay 2008 42.000 for 2010 pay 2011
Lesser of 12 qq�000 for 2008 pay 2009 41,000 for 2071
Homestead Valuation �Y 2012 S
« 43,000 for 2009 pay 2010 40,000 payable after 2012
SignaWre of �ta Date signeA (rrmnlh, tlaY. Y��
SfATE FORM 9569 (R1I8-10) 'fItEASURER F00.\I TS-IA
APPROI'ED BY SiATE BOARD OF ACCOU�TS, 2009 PRESCIUBED 9Y THE DEPMT�fE�T OF LOCAL GO\'EA���.�T FI�A\CE ICbl.l-'_?-8.I
' � Q� � � 0 � � s O � s � e L_l
Individuals and married couples are limited to one homestead standard deduction. As the receipt of'this
deduction becomes more beneficial, there is more incentive than e��er for homestead fraud. Humestead fraud
�causes higher tax bills for all; therefore, HEA 134�1-2009 requires taspay�ers who receive the homestead
s[andard deduction to ��erify that they arc eligible to receive the benefit and to provide additional identify�ing
information necessarp to allow count}� government to better monitor homestead filings. Thi:: information
�vill be kept confidential and can only� be accessed by authorized count}� officials. The Department of'Local
Government Finance will use this information to create tools that will help count�� officials eliminate
homestcad fraud.
Tunarer \ame
Carl W Harrison
Canple�e and return 10:
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ONer (P�� sC�Y n Can a Delv,v)
}�in1iY 150 /� �,
as pmperty atltlreu
4�� 7�
9se OJrer (please speofy n f'art 4 peb.v)
I � 1 � �
Each undersigned certifies, under penalty of perjury, thal ihe above and foregoing infortnation is true and wrrect and that he or she fs eligible to recerve �
homestead standard deduction on ihis property. Each undersigned also understands thal, by claiming additional homestead deductiors unlawfully, he or
she may be 1ia61e f taxes and substantial financial penalties.
Ownt�Sgna:ur / t Date Teleptwna -
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