Homestead_Milheiser (3) B STATE FYFM 51569(PS/]{M/
APROVEDBY STATE BOARD WAMOUNTS.2099 TREASURER WBMTSIA
PRESOUBED BY ME DEPARTMENT OF A (T
FINANCE C 6-1.1-21-8.1
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 1: PROPERTY INFORMATION
Property Address(number and street,city,state,and ZIP code)
� Ia1M S Prince Prince±on 11-( .L17 (0-76
State Parcel Number
Ia - 1B o3 — col . Ig40 - 0af
PART 2:TAXPAYER INFORMATION
Owner 1 First Middle Last
5.
CC I \ Ilheiser
Mailing Address(number and streit,city,state,and ZIP code) fra Same as property address
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
sme
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 T$ attire Date
j
( )
PART 4: ADDITIONAL INFORMATION
INSTRUCTIONS
I I
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Stata Form 5473 (R6 / d-03)
PtasaiEeE by Ihe Department of local Govemment Finance
INSTRUC710NS: See ieverse side for filirg inshuctipns.
�
� FORM YEAR
� Pr.4��o1 9 2 06 '
I(We) �J �/ ✓ certify lhat on the 1 st day of March, 20_
I(We) occupied as our prin 'pal place o( residence the following descnbed real property for which a Homestead Property Tac Credit is hereby daimed:
�'(We) owned LJ Are buying under wniract
Have a benefidal interest in lhe entlty that is liable for the pmperty taxes on ihe pwperty and that owns the property or is buying under a conVact.
I( buying om m�Vact, Fee Simpie ownefs name
where conVaa is recorded
Counry
Tavnship
Parcel numher I Lega� npl'iy� �� Is Ihe
�/9-O// ��� - �2l ��ua
If any portion of Ne residenUal sW ctura w the land not exceeding one (1 � aae that immediately surtounds
of the propery uW¢ed tn produca irrcome.
Counry
Tavnship
1 hereby certify the above statemenfs are We, corred and complete.
(number arid s6ee( city, sfate, ZIP code)
Coumy
Record number
fown, fownship)
Page
property in questian:
_�ea� o�oaenv ❑ Moa�e Ha„o (LC. � r. �-n .
h swcture is used W produce income, tlesuibe the use antl portion
ravnsnip
� �`�i ��a. :� rz.s�s�' �z. - �t -i-^"�- "" �, �. . -„"�"' ' .� NON'•RESIDENTIAL -"-. ,
�'�?��"�� ASSESSOR USE ONLY �- ` t��"' . TRUE�TAX , ASSESSED VALUE �HOMESTEAD F` � 3•'
H«i�`�at.i; s ���?;::�: _ � � s ��ts�'._�.1 �':.VALUE�,.� :AT�100%.OF,�TN�' �^T."`-;n?EVALUE�? E. �"���5'.rVALUE�������
--.. � as,.�
Land not exceeding 1(one) acre immediatety :n�"�F t�7,�;�. y�� 4 +r.�C`
sunounding residential improvements. ��) �,���'���vt��"�f
,�a^ :,s'::
Other land ( � �N`�"}�'� ��.�;.�'
Z ``,y, :«k�`�'.r �?'�
Tdal land (line 1 plus line 2) (3�
f ��s� d��
Dwelling (4) :�.i. rM�� �
�Residentiel improvemen4s or Mnually �"��^�� '^��r �'
Assessed Moblle / Manufadured Home Garage (5� ��,x }� �'�;���3���`���
r
��..a' -is..�. ..�.'�+{ �Y'
Oiher improvements (5) s-. s°�"'�1-�•;r:`'��Fi
T�`7:iz �T;��
TUaI improvemenLs (line 4 fhrough Irne 6) (��
Tctal value (line 3 plus line n (g�
I hereby certi(y Ihe above is We, covect, and Signature otAssessor Date sgned
comptete.
Verifying action - Signature of fwditor Date signed
20_Pay20_
Lesserof 1/2 Homestead
vauanon or 535.000 S