Homestead_Coleman (5)�
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,,.�_�:�.•� CL/11M FOfI FIOM[ST[AD PROPEf1TY TAX-
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;� ��I� C(iEUIT/Sl'ANU/1fiU DGDUCTION
`��f:� Slale Fonn 5473 (Il7_/I-90)
"�' lNSTif.iUC770NS: See ieveise siJe !or liliny insbuclions. �
0
I�Wfs}ecsuyied�saur p�incipal place ol
Pwperly �iax Credil is lie�eby daimed:
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ronM
IICIU
. .� .,
vEnn
�W.�—Eeilily I on Ilie I sl Jay ol Maich , 19 �
ii�ei) real propeily for wliicli a l IoinesleaJ
(We) owneJ ' U �re buying uiider conUacl
� I lave a benelicial inleresl in Ilie eidily Ilial is liable lor Ilie pi�peily Iaxes on Ihe propei ly and Ilial owns Ihe
propeily or is buyiny il ui�Jer a coiiliacl. ,�� � ��� ��
II buyiny on conlraci,
Gouniy
ollice wliere cqnlracl
, .+
CO�d f(1/1CT`RECOnDEU
u
PfiOPERTY UESCf11PTIOIJ
� l ownship I axiny Uislrici (Cily. lo i, I
; �� I Legal Desciiplion _ �.�'_,� . . T--
40
U any poilion ol Ihe residenlial siruclwe or Ihe land noi �xceediny one ( I) acre IhAI inuneJialely suriadnds Ilial sh�c-
luie is useJ lo pwJuce income Jesciibe Ihe use anJ poilion ol Ihe piope�ly utilizeJ Io produ�e income. q7D�1 y
v����n
—�
PfiOPEl1TY UW17ED OY CLl11Ml11dT IN OillEfl COUtdTIES
� Township � � Counly � Iuwnsliip
I liereby ceiliiy IDe above slaiemeids a�e due, conecl and
Idress (SUeel, number, ily, sl e anJ ZIP� �vJe) / ' � % � l/�. Z-�✓
//�.feG.r✓�v, �i.✓��f�<.9,C�(/�,�, `%/%Di•:,« , Y7C7o
ASSESSOf1USEO1ILY if1UETA%VAIUE 115SESSEUVAI.UE IIOMESIEADVALUE f1011�f1ESi�E17IlAL
VAIUE
Land nol exceedinA I(oue) acie hnmeJialely
suirom�Jingresldentialimprovemeids (�)
Olher land (Z)
Tolal land - ILie (I) plus fine (2) (3)
Ilesidenlial buprovemenls Owelling (4�
Gaiage (5)
Olher improvemeids (6)
Tola� Improvemeuis - line (4) Ilrtoug4line (6) (%)
Tolal value - liiie (3) plus line (7) (0)
I hereby ce�lily Ihe above is Irue, SiynaWre ol /lssesor Uaie Siyned
coneci, anJ complele _ _
enl-' y iTig hcUo— i S gnatu— ie oT AuJilor Uale Siyned
srnri�nn� uEUUCTiora n��awnNCE
1989 Pay 1990 1990 Pay 1991 1991 Pay 1992 � 19 — Pay 19 —
lesser ol 1/2 I IomesleaJ Lesser ol I/2 FlomesleaJ Lesser ol 1/2 Flomeslead Lesser ol I/2 FlomesleaJ
Valualion or $7_,50U Vatualion or $7_,000 valualion or $1,500 Valualion or $1,5U0
SignaNr �ol%f�uditor �ale Signed
/ 17 /1. /L�4 r. • A l �t /� .S- %' �
SfATE FDRM 33369 (Rl1&10) TRFASUAER FORN TS-IA
MPROVED BY STATE BOMD OF ACCOU\TS,'_009 PRFSCRBED BY TNE DEPMTAf�T OF I.IX:\L CA�'FA,\NE\'� FTA,ICE ICbl.l-22-8.1
� O � , 0 � . ' / � , 1 � � �
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
�uses higher tas bills for all; therefore, HEA 1344-2009 requires taspayers ���ho receive the homestead
s... dard deductiou to verify that they are eligible to receive the benefit and to provide additional identifying
informatiou necessan' to allo��� county� goverument to better monitor homestead filings. This information
will be kept coufidential and cao onl�� be accessed b}� authorized couuty officials. The Department of Local
Government Finance �vill use this information to create tools that rvill help counh� officials eliminate
homestead fraud. �
Tama.er �ame
Richard A Coleman
Complete and return to:
om,�r i
��`-^ VI �
Maiting AGdress (nuirGer aeq Weel. �
soda�
0
Lreal Dn<rinHOn:
HALLS?ND 20 PV31 PT
�0 ��
/ �el �����,lY-�
Same as woxrty atltlress
"" ourer Wease weaN �o aan a ee�w.>
� � ' .
AtiEAe L
Co(ernav�
Same as property aEdrrss
T �
.
Each undersigned ceNfies, under penalry of peryury, that the above and foregang infortnation is We and wrrect and that he or she is eligible to receive �
homestea ndard deduc6on on this property. Each undersigned also understands that, by Gaiming additional homestead deductions unlawfully, he or
she be li le fw back faxe�and substantial finandal penalties.
/� /
Date
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il�U�k�IZ
Telepnme
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NOV 5 Z��Z
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