HomeMy WebLinkAboutHomestead_Lee (6) \TE EC*M S`Si9IR�11M) TREASURER FORM TS-IA
BY STATE BOAPD4ALlV11MS,:(g9
PRESCRIBED BY THE DEPARTMENT OE LOCAL GOVERNMENT FINANCE IC 61b:2-8 I
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
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 causes higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the
homestead standard deduction to verify that they are eligible to receive the benefit and to provide
additional indentifying information necessary to allow county government to better monitor homestead
filings. This information will be kept confidential and can only be accessed by authorized county officials.
The Department of Local Government Finance will use this information to create tools that will help
county officials eliminate homestead fraud.•
• - - PART I: PROPERTY INFORMATION -
Property Address(number and street,city,state,and Z code)
a 3 0 o X a_4 /fit co l a 7 c7
State Parcel Number
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SS[EP —
2 3 2013
MC
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
9..„e„..---Mailing Address(n ber and street,city,state,and ZIP code) /n n/Same as property ss
p_o . N 0' 3y5 1 Aknt,c�or-i c! y, Ll 1470
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
Srue
. PART 3:CERTIFICATION - • . - -
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is
eligible to receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional
homestead deductions unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Signature Date
•
INSTRUCTIONS
M\I PR-sae, )4
iOflM MC 10 1979 � To & FileG in Duplicaie
FeuriEtO By State Board ol Tas Commissioners
CLAIM fOR HOMESTEAD PROFERTY TAX CAEDIT FOR•YEAR 19�
./
SEE BACK FOR FILING INSTRUCTIONS o�9 - ol� a 4' d fl
�We) `y� `� certify that on the 1st day of
"�arch, 19�`L, ,(W occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: .
I, (We) CLOwned
❑ are buying under contract
❑ have a beneficial intere,s,t/ in, �th�e taxpayer �/�
Property Description in �v� County �f'�n Township
Taxing District (City, Town, Township): �/Ll/JC�t.c��+-� �c/h�.tC� /�
Parcel Number or legal description shown on tax statement:
�C.i.R� .S<.�..�i- A-QJLC✓ �� �
If buying on contract: Owners name (�� simple ow�e��
Contract recorded in Recorders Office - Record No
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe the use.and portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property: County Township
�hereby�certify the above statement is true, correct and complete.
✓
n
.
and Zi0 �e
Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
Total Land
Resideniial Improvemer� � ` �'' �' welling
t�o
l�
arage
Total
� 4� � � �, i.979
Other Improvements
-47� Improvements - +rf� (�lu equal (8)
`7�aby certify the �e ,tr4e e d omplete.
Signamre ol
True Cash
Value
(,� aS 90
(2) —
(s) �?S90
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- ACTION BY AUDITOR -
Assessed
Valuation
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P(� o
Homestead
Valuation
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Approved: a�� � Date: 7� y�y