HomeMy WebLinkAboutHomestead_Hyneman (4)FORM HC IU 19i9
PreuribeE By State Boa�G o� ia. Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREOIT FOR YEAR 19 7 y
0 0 �y-��•P�a
� (We) � - m<-a--.
arch, 19 I, (We) occupied as our principal place of residern
which a Homestead Property Tax Credit is hereby being claimed:
To & FileG in Wpli[dte
"�" certify that on the 1st day of
following described real property for
I, (We) �owned DD�V abqs I
are buying under contract
❑ have a beneficial intere�sy,jin the taxpayer
Property Description in �`-"�"� County ���^ Township
Taxing District (-�iLyrTew�Township): ��c-�
Parcel Number or legal description shown on tax statement: 6
��f.�ivE -�„ ''y �i-i-io r�aJ
If buying on contract: Owners name '!�
Contract recorded in Recorders Office - Record
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property:
�hereby certify the above statement is true, correct and complete.
/�3
Sveet Aoaress
County
Township
Giiy. State ano Zip
Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
Total Land
Residential Impro er en� � � �
.JUN t ti 1919
Other Improvemen
T��Improve s,
I .aby certify the�
Sig�amre ot nssessoi
Dwelling
Garage
Total
e pl s ( als (8)
e is true. or��c' and complete.
True Cash
Value
��� �o 0
(2) S c
(3� SSo
(4) / 9S 90
(5) '�
�s� i 9s 9�
(�)
�s� � 9sgo
- ACTION BY AUDITOR -
Assessed
Valuation
/70
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Homestead
Valuation
/ 70
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Da:e
6
Date: — . —.�/'�1 —'�—�
i
STAiE FDRN S1569 (R'_9-09) TRFASURER FOkN TS-IAI
dPPROYED BY STATE 60ARD OF ACCOUSIS. ?009 P0.ESCfUBED BY THE DEPARTME\T OF LO('AL CAVERRME` �{TASCE IC6LId2-8.1
� O � / / , . O 1 �' 1 � i � �
Indi��iduals 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. Homestead fraud
�auses higher tas bills for all; therefore, HEA 1344-2099 requires taspayers ���ho receive the liomestead
standard deduction to verif}� that they are eligible to receive the benefit and to provide addition;il identifying
information necessan' to allo«� counh� go��eroment to better monitor homestead filings. This informatioo '
will be kept confidential and can onl}� be accessed by authorized 'county officials.: The Department oC Local �'
Government Finance will use this information to create tools that will help county officials climinate
' homestead fradd. '
Taxnnrer\�me '
Thomas L Hyneman
Complete and return to:
P�ntt 1
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�/7o/�9�s •
Maitin9 ��ress (nwEer ana streel. ary. sL
�/sz F_ 2 do v
Sotial Seaniry NurtCU (bst 5 Clglts)
�
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' ' htidNe
Orivers Lianu Su;e ID Nurtbei (USt 5 alplb)
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Each undersigned certifies, under penalty of perjury, that Ne above antl foregoing intortna6on is We antl correct ana mat ne or sne is e
homestead standard deducUon on this property. Each undersigned also understands that, by Gaiming additlonal homestead deductlons
she may be liable for back taxes and substantial finandal penalties.
Ovmc 1 Si�aMe Date Telep�one
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PART 4: ADDI'I'10\AL
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