HomeMy WebLinkAboutHomestead_Donnelly (3)� } CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� S�a�e Fwm 5473 (R6 / L-03)
Prescribed by the Department ot Local Govemment Finance
INSTRUCTIONS: See reverse side /or liling insfmc(ians.
I (We)
I(VJ�upied a�'Ibur principal place of residence the following described r al mperry for which a Homestead'Pr6peity 7�i Credit is,her by.daimed
I(We) ownedV ❑ Are buying under contract �' GiBaUt� l-'-�'_' `
Have a benefidal interest in ihe entlty that is liable for the property taxes on Ihe property and that owns lhe property or is buying under a wnVaG.
FORM YEAR
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If 6uying om m�tracl, Fee Simple ownefs name
Recordefs ofice where conVaa is recwded
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Legal description
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Record number � Page
I I �eal Draperty ❑ AAObile Homo (I.C. 6f.1-7)
w the land na exceeding one (1) ave that immediately wrrounds that swcwre �s used b praduce income, describe Ne use antl portbn
' �'�t�-.a�',�'i��`"�,.�,-..,�,���,i���STANDARU:DEDUCTION'ALLOWANCE'���'..,�.��,..���,. �.�� -_ > .�,,�»Y
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20_Pay20_
Lesserof 1/2 Homestead 5 ,
VauaUOn a E35.000
SynaNra oilwditw " Date signed
SfATE FORM 53569 (It3i8-10)
.�PPftOVED¢! SiATE BOpRDOFqCCOUMS, 2009
TRF.ASURER FORM T$-IA
PRESCRIBED BY THE DEP.VtTME�T OF IAUL GOYERNM6\T FfTqFCE IC61.1-22-8J
Indi��iduals and married couples are limited to one homestead staudard deduction. As the receipt of this
�luction becomes more beneficial, there is more inceotive than ever for homestead fraud. Homestead fraud
.auses higher tax bills for all; therefore, HEA 1344-2009 requires taspayers �vho receive the homestead
standard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
informatiou necessary to allow couuty go�•ernment to better mouitor homestead 6lings. This information
�r•ill be kept conflideutial and cao only be accessed b�� authorized count�� officials. The Department of Local
Go��ernmeot Finance ���ill use this information to create tools that �vill help county officials eliminate
homestead fraud.
Taioarer \'ame
Jon Donnelly
Comp(ete and return to:
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Maiti�g AtlEress (nurtter aM street, d
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sodal senaiq Mmtcr (h:� s eh�ts)
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s«w s�my r�,rmg ro:� s aroie�>
Leeal Dncriotion:
DEVfNS ENLG 1 PT
MiOtlle
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as propeny aOtlress
Pan � eeluv)
MidNe
�'Sartie as O�WU�Y aaEress
Dnvers Licensel5ate ID NurtCer (last 5 tllB�v) � Ot�er (pease speary in PaM1 d below)
caa� unuers�gneo .:erunes, unaer pena�ry or pe�ury, mat me aoove ana roregang mrormauon is vue ano correa ano ma� ne or sne is eugioie ro recerve i
homestead standard deduction on this property. Each undersigned also understands that, by Gaiming additional homestead deductlons unlawFully, he or
she may be liable for back taxes and substantial financial penalties.
Ovmer 1
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