Homestead_Enyeart5��� ��u%i�4(�1PI01
APPRO\'Fp 6Y SfATE'BO.1AD OF ACCOII�TS. =009 PRfS('R/BED BY?i!E DE➢ARiA(E\TOFLOCpL GOl'ER\',NE �FT Uj.�R ER��� y e 1
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Indi�'i� and married couples are limited to one homestead standard deduction. As the receipt of this
deduct o�comes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
�causes higher tax bills for all;-therefore, HEA 1344-2009 requires taspa}�ers �r�ho recei��e the homestead
Ttandard deduction to verify that they are eligible to receive the benefit and to provide additional identif��ing
informatiou necessarp to-allo��� counh"go��ernment to better monitor homestead filings: Thisintormation`;_
L will be kept coufidential and-cau only tie accessed�6��-aufhorized°county'officials. The D'epartineot of Local ,
Government Fina�ce �vill use this:information to create tools tfiat �vill help county officials eliminate
� � " _ _.. . _ ._ homestead fraud.
TaznarenYame ���� � `—"-"�'"" Pmnern��Address „_; �,.,.� � __ Sure Parcel �umber Leeal Descrinlion: . ..
Clay D/ Jennifer
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as property aOCress
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sodai secvnb rmrttc Imsi s me��) � . omen i�s�s�ie io rv��..�v:� s maiu> ��� .�� •,-. 'o':tier lWease sv�N in Pan a beiv,.)
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homestead standard deduction on this property. Each undersigned also understands that, by Gaiming additional homestead deductions unlawfully, he w
she may be liable for back tazes and substantial finandal pena�ties. ��
Owner 1 Si�aMe Oate . .. . . TeleM�e
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�° i CLAIM FOR HOMESTEAD PROPERTY TAX
���'� CREDIT/STANDARD DEDUCTION
�,.��� State Porm Sa73 (R2 / 5-92) �
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INSTRUCTIONS: See reverse side !or liling instructions.
n� /� � � � - �� ' � ' ���CERTIFICATIi
FORM
HC10
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I(We) ---I ��'�7� � L�C� . • certify ihat on the 1st day of March, 79
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� occup� s our pri i I place of residenc t fol�owing described real property for which a Homestead Property Ta�c Credit is hereby claimed:
i_I I (We) owned re buying under contract � -*ir'. 's, -< - . ,- _
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❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pro�feriy or is buying under a contract.
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If buying on contraci, Fee Simple owner's name
Recorder's office where comract is recorded
Counry
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If any portion ot
ot the property i
CONTRACTRECORDED-
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Page
' Township . Tauing tlistnct ity, owq t wn hip) � ,'
Legal description . .
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sidential svucture or the land not exceeding one (�1 acre that immediatety surmunds that strucmre is used ro produce income, tlescribe the use and portion
�� to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Counry Township Counry Township
eby certify the above statements are true, correci and complete. Signa� claimant
�-
Address (nu er and streeC city, s�t te, ZlP code)
5o . B�aoa�µ_, ;N�erP-s� ZiV � 7G za
ASSESSOR USE ONLY , TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
,VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately �
surmunding residential improvemenis. (�) �
Oiherland � (p)
Total land (line 7 plus line Z� (3)
Dwelling (4) . . -
Residential improvements
Garage (5) -
Other improvements (6)
Total improvements Qine 4 through line � (7)
Total value (line 3 pUs line 7� �g)
I hereby Cenify the above is true, correct, and Signature of Assessor Date signed
complete.
Veritying action - Signature of Auditor Date signed
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r
19 Pay 19 _
Lesser of 1/2 Homestead
Valuation or 52.000
STANDARD DEDUCTION
3
S%e of Audiror �� r\ ('�/ �� I Date
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