HomeMy WebLinkAboutHomestead_Fleming (2)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
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Preavbed by Ihe Depe'6neni d Laal Gorerrmard Fmmim
INSTRUCTIONS: See ieverse side for filtirg insbu6ons.
I (We) �L (! I V / �y,
I(We) ooapied as aa P�aP� P� of rPal property irh Fiunestea
��(We) owned ❑ Are Wryug unda mntraU
Have a benefidal c�terest m the entity Ciat's liade tor tlie properly �ces m Uie popaty and C�at owns U�e
FoRa�
HC10
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�7 of March, 20_
i is hseby daimed:
i�b� under a mntracl
ITY AUDITOR
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tf Wy'�q on mitra0. Fea Sirt�le a.aiefa rrame
FLecutlefs d6ce whaa mMed ia reraded Remd numher Page
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tA Ihe poperty uLf�d b pioAce'uwvne'
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used to yod�ce iimna. dma�a tha �ma md pu0on
a,.� -. -. r � 7xS'{ i� A 7%IE:TAX � ASSESSED VALUE r f�MES7EM' . n MONatFSIDENiIAL' "�.�'r�' �p..�
i� r� 3 x/�SSESSOR USE diLY� ��K'"IK'`+ VALUE?'rs; ��'AT 100% OF TTV 2° � VAUIE F' f�. �' t"'+2�;.SVALIIE ""'�1- 4%�"�
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LarM nd exoeedng 1(one) eae irmiedately x.,` ra' �- s` �r ��^ ��, ,�<��'��',�„
S�alamd'v�g fe5idential im{xoven�en�- ��� :e�'� uA-. � iR,�,� S ee'�
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ResdenEa� cnprovenerds ornnrvaty �`� (4� ^ '' �,'��# r'�t' ,'^v'::�y�7s..,�,r�i
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VY�d unprovert�erits (s/ ...�,.�;,,i
Tdal cnprwemerAS (!rre � Wa� 8ne 6) (7)
Tclal value (I'aie 3 pGs Gne � (g)
I heteby certiy fhe aDwe is We, mnect, ard Sig�re of�r Daae sgied
mmplete
�%riryup eawn - Si�ahae otadmr Dam signed
�y'Y.'
20 _ Pay 20 _
Lesser of 12 Homestead
V9uation w 53.5,000
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sr,�re rogu s�s;o pvsasl rn�suxEe row�+is-iri
APPRGVED BY STpTE BOMD OF ACCOIJ�TS. _'009 PftESCRIBED BY THE UEPARTMFI�T OF LOCAL GOVERNMEM FTANCE ICbIJ '•_-H.1
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Indi��iduals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more iucentive than ever for homestead fraud. Homestead fraud
�auses higher ta� bills for all; therefore, HEA 1344-2099 requires taxpa}�ers who receive the homestead
s.andard deduction to ��erify that they are eligible to recei��e the benefit and to provide additional identifying
information necessary to allow counh' go��ernment to better monitor homestead filiags. This information
��•ill be kept confidential and can onl�� be accessed by authorized counh� offcials. The Department of Local
Government Finance will use this informatiou to create tools that will help couuty officials eliminate
homestead fraud.
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Tama�er \ame Procern' Address � Stah Parcel Yumber Leeal Descrio6an:
BIaAe E Flemine —' � 31i S Race —'�' —" '— �-�' �- 26-12-07-401-002.796-028 019-02796-00 PT SE 7-2-10 14 AC ��
Princetan fN 47670
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Camp(ete and return to:
GIBSON COUNTY AUDITOR 101 N•Di.UN PRINCETON L\ 47670
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Ovmer 1 Fies� AtiCEIe
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nWUing AENess ln ana weet d. state aM ZIP woe) gyme as propa�y aearess
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Sada� SnwiN Nwtc (ms� s eiei�s) Dmefs Liarne Slate ID Nurtber (last 5 Elplb) sa o�,c (pease wroh � aan a eeiaw>
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Each undersigned certifies, under penalty of peryury, that Ne above and foregoing informatlon is We and correct and Nat he or she is eligible to receive the
homesiead standard deduction on fhis properry. Each undersigned atso understands that, by daiming additionat homestead deductions unlawfully, he or
she may be liabte (or back taues and substantial finandal pena�ties.
Ovmc 1 SyaSUe Date TMephone
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