Homestead_Smith (26)_ .�
d���•,t CLAIM FOR HOMESTEAD PROPERT�Y TAX .
�.'!`: y �;: CREDIT/STANDARD DEDUCTION.
' State Form 5473 (R2/1-90) ' '
�'°�• � INSTRUCTIONS: See reverse side for filing.instructions.
CERTIFICATION STATEMENT
_ _ FORM __
HC10
a
YEAR
a 1t .11�!1L�� -
I(We) �� _� _ certify that on the.lst day opf� Meyarch 19q
(i (We) oc uc pieM our principal place of residence the following described real property forVvRi�h� �oPfi �Stead
Property Tax Credit is hereby claimed: ❑ I(We).owned ❑ Ar in u�de� n r t
� Have a beneficial interest in the entity that is liabie for the property tazes on the property��i� ns the
property or is buying it under a contract.
County
CONTRACT RECORDED
on coniract. Fee Simple Owner's Name
's office where contract is recorded
��«��a
P.ROPERTY DESCRIPTION
Taxing Distric
Legal Description
town,
Number Page
If.any portion of the residential structure or ihe land not exceeding one (1) acre that immediately surrounds that
ture is used to produce income describe the use and portion of the property ut� ed to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Couniy
hereby certify the above siatements are true, correci and I Signature
Address
ASSESSOR USE�ONLY. _
state and ZIP code)
TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE
NON-RESIDENTIAL
VALUE
Land noi exceeding t(one) acre immediately � �
surrounding residential improvements (�)
Oiherland (Z)
Total land - line (1) plus line (2) (3)
�Residen[ial improvemenis Dwelling - (4) -- - � — - - -
- Garage (5)
i
Other improvements (6)
Total improvemenis - line (4) ihrough line (6) (7)
Total value - line (3) plus line (7) (8)
I hereby certify the above is true, Signature of Assesor Date Signed
correct, and complete
Verifying Action - Signature of Auditor Date Signed
1989 Pay 1990
Lesser of 7/2 Homestead
Valuation or $2,500
STANDARD DEDUCTION ALLOWANCE
1990 Pay 1991 1991 Pay 1992
Lesser of 1/2 Homestead Lesser of 1/2 Homestead
Valua[ion or $2.000 Valuation or 51,500
19—Pay 19—
Lesser of t/2 Homestead
Valuation or 57,500
Signature of Auditor Date
� ,. „ .,.. .� � �l I c Q , 2 �
STAiE FORN 53569 (R3/&10)
APPRO\'ED BY SlAiE BOAAD OF ACCOII�TS, ?009
TRFASURER FOR.N TS-IA
PRFS[RIBED BV THE DEPAATME\T OF LOC,LL CAVF.RT�¢Yf Fl.�'A.\CE IC61.1 .2-8.1
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
�Pduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
�causes higher tas bills for all; therefore, HEA 1344-2009 requires taxpa}'ers who recei��e th;e homestead
standard deduction to verify that the}� are eligible to receive the benefit and to provide additi�inal identifying
information necessary to allo«� count}� governmeut to better monitor homestead filings. This information
«�ill be kept coofidential and can ouly be accessed by authorized county of5cials. The Department of Local
Go��ernment Fivance will use this information to create tools that ���ill help county officiais eliminate
homestead fraud. !
Tssoavrr Same
]effers Eugene / Karla L
Smith
Complete and return to:
o.,,g i
�.lt°-F�e�S' �` ,
r.��+s nee,� ��,eg am roee� �
aM
ONx Weaze sOectlY in I'M a bebw)
i
/ � �' �
�
��, �
�h� i��
Same as papem/ aEGeu �
Sctlal Seaairy N�nnber (luf 5 dipib) Drivo�s LicauB151ate ID NumDer (last 5 Glglb) �e OUrer (please speuty in lian 4 Eebw)
�
.
�
Each undersigned certifies, under penalty of perjury, that the above and foregoing in(ormation is true and wrrect and that he or she is :Iigible to receive �
homestead standard deduction on this property. Each undersigned also understands that, by claiming additional homestead deduUions unlawfully, he or
she may be liable for back taxes and substantial financial penalties. i
Owner 1 Sl�atwe ,� _ Date
�'�-