Homestead_HermanCLAIM FOR HOMESTEAD PROPERTY TAX
CREDR/STANDARD DEDUCTION
� st�e r� sa3 Rt� i s a5)
P�escnLad by Ihe Depertrt�enl of Loml Govemman F"vence
INSTRUCTIONS: See ieverse side lor filing instructions.
�
FORM
HC10
YEAR
I M�e) °�' certify that�ie �t �a�9PMarch, 20_
I(We) occ�pied as ' dpal pWce W residence the fo0owirg desaibed real property Gw whMh a Homestead Property Tac Credit is hereby dairtred:
�(We) owned ❑ Are buying under crntrad `�f6� ,Q �
iave a benefidal mterest m the entity fhat is liade fiw the propeAy taxes on Ne property and that ams ihe propeM.o�isv�huYu� y(�@('9_'GSntract
GIBSOi�
K�M9 an WnU'acl Fee Simple ownefs name
coiairy
Parcd roimber
Tnvrohip
Lepal d�criplion
Tmmy di�trjtljcd�faim� township)
Is ihe
H arry partion of ihe resiAenlial struMe w the lard rwl mmeeding one (t> aue that unmedatey surmu� Iha1
d U�a MoPertY tAiGmd b P�duce uimne.
P+ K4� �-I -io /. 3S4
�G-v�- 3i-aao - U�•��5 =G�.7 ,,.. , M � .
Counry
Tuvnship
I hereby oeAi(y tlle above stahmen� are true� correct arM conple0e.
(nmMer erM street �: sfafs� ZIP oade)
Counry
Recad number I Page
Mo6ib Fiome (I.C. 6f. f-n
b pioduce'vimme. describe iha use and portion
�x�"4'a���R-:�a`I'!-��.sS�'tv+'3+i"e n: +.��d''..C.'o� ���' _ . � �IX.yn��n.:tic�il,4`.t..7_..1`.�IYf-:;�.exl°)N?�� e..�i:��nt�":�f
�'.:� va2.M i.la,:tSTANDARD'DEDUCiION'ALLOWANCE, } •�i'ei , .;il : t;n'L.�'t.'�'r`�i4?;�W.,
. 20_Pay20_
Lesser of 12 Homestead E
Valuatim or 535.000
signahue af Autlitu Date signed
tK.
STAiE i0R\I 53569 (R7l&10) TAEASURER FOR.N TS-IA
APPRO�'ED BY SfATE BOARD OF ACCOUYfS, 2009 PRESCRIBED BY THE �FPAATl.��T OF LOCAL GOVER.L"�M Fl�A�CE !.61.1-22-8.1
, 1 � / ' / . ' 1 \ , � � , � '
Indi��iduals and married couples are limited to one homestead standard deduction. As the receipt of this
�luction becomes more beneficial, there is more incentive than ever for homestead fraud. H��mestead fraud
causes higher tax bills for all; therefore, HEA 1344-2009 requires taxpa,yers �s•ho receive th'e homestead
standard deduction to verify that they are eligible to receive the benefit and to provide additinnal identif}'ing
information necessary to allow county goverument to better monitor homestead filings. Thi,� information
will be kept coufidential and can only be accessed by authorized county officials. The Depan'.ment of Local
Go��ernment Finance will use this informatiou to create tools that will help couoty officiaas eliminate
homestead fraud.
_ _ � TainaverName_ _ _ _
Grady B Hemtan
Co�nplete and return rn:
PaTBr 1
�
�
Each undersigned certifies, under penalty of perjury, that the above antl Foregofng informatfon is We antl conect antl lhat �e or she Is eligible to recerve �
homestead standard deduction on this property. Each undersigned also understands that, by claiming additional homestead deductio.is unlawfully, he or
she may be fiabie for back taxes and substantia� financial penalties.
Owner l Sipnanae Data
GIBSON COUNTY