Homestead_Miller (10) •
STATE FM1433369(RI fl'9) TREASURER FORM'MA
APPROVED BY STATE BOARD CE ACCOUNTS,2C09 PRESCRIBED BY THE DEPARTMENT CF LOCAL GOVEXM ENT MAPCE C 611.2,5.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
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 ever for homestead fraud. Homestead
fraud causes higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the
homestead standard deduction to verify that they are eligible to receive the benefit and to provide
additional indentifying information necessary to allow county government to better monitor homestead
filings. This information will be kept confidential and can only be accessed by authorized county officials.
The Department of Local Government Finance will use this information to create tools that will help
county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Property Address(number and street,city,state,and ZIP code)
'd1 350 5 Pte ,
I State Parcel Number
ato- ► a - aq - A-► oo 0o I . 73Co - oa -FILE„D.
JUL 2 4 2014
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PART 2:TAXPAYER INFORMATION OR
Owner I - First Middle Last
Mailing Address(number and street,city,state,and ZIP code) Same e as property address
, •
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
5b1c
PART 3:CERTIFICATION
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.
thsne I ature "� Date
( )
PART 4:ADDITIONAL INFORMATION
i I I
n h rr. o
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INSTRUCTIONS
, CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
/ Slate Fwm 5473 (R6 / 1-03J
Prescribed �y the Department of Local Govemment Finance
INSTRUCTIONS: See ieverse side lo� liling insfmcGons.
FORM YEAR
HC70
� �i `- „--� -
�( , j ! { .
�y e' i?,J 7. �
� M�Q) �(, �� /'Y�/� ////1�� certify t�hat on the 1 st day of March�20 �
I(We) occupied as our principal place of residence the following described real pmperty for which a Homestea JPropeAy TacrCredi� isheFeby d'aimed:
� G;dS�J>! CDU'I i'f „Uql �CR 1
❑ I(We) owned ❑ fve buying under contrect
, Have a be�efidal interest in the entity that is liable tor ihe property taxes on the property and ihat owns the property or is buying under a conVact.
If buying om m�Vact, Fee Simple owners name
Remrdels office where conirad
CounTy
Tamship
N any poAion of Ihe residenUal sW cWra or Ne IanA not
ot ihe property utilized ta praduce i�ome.
Record number � Page
IslheO�operryi question: '
� 9— %. '� O a• p„��Real Droperty ❑ Mobile Homo U.C. 61.1-n .
one (1) acre ihat immediatery wrrounds ihat wcture is used b produce income, desaibe the use antl portion