Homestead_Tignor STATE F M53%9(P3/)i 9) ----_ W wm TBE SURFA nYtMiilA
APPROVED BY STATE BOARD CE ACCOUNTS.1039 - m^BY THE[YARTI.@1r OF GOVERM.4 4T FINANCE CS-1.13S8.1
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)
OR 5/ 3 s sR S7 &laic/ �' 5‘7/0‘5‘7/0‘,6"State Parcel Number 9- .k
Z6-13 — a cRoo Coo 055 004,
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Steven W T 13 ),(6 Y'
Mailing Address(number and street,city,state,and ZIP code) FA Same as property address
Spouse First Middle Last
I I
Mailing Address(Number and street,city,state,and ZIP code) n 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)
Stale
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 Sim ture Date
7 � )
PART 4:ADDITIONAL INFORMATION -
f
-
INSTRUCTIONS
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
Stale Form 5473 (R61 4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for Ming
MAR 4
tr..: -.. I - CFJTIFICATION STATEMENT - . '. z
YEAR
I (We) ),4 Z&fL� 4CI. certify the 61 n the 1 st dj?0'fMa,#,, 20
I (We) occupied as our principal place of residence the following desc ad real property for which a Homestead ProlpeRHOSAA0`16,Allto"d:
❑ I(We)owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACT RECORDED---:
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Record number Page
__e
PROPERTY OESCRIPLTIONF X-.'
County
Township
Taxing r) (city,
Township
-PV
17
Is property in question:
Address (number and street, city, state, ZIP code)
c?, (' ?
❑ Real property ❑ Mobile HOMO (I.C. 6-1.1-7)
If any portion of the residential structure or the
tend 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.
Signature of Auditor
surrounding residential improvements.
I&
-''-, PROPERTY bWNEDBY CLAIMANT INOTHEKdOUNTIES
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Sign :f c�/
Address (number and street, city, state, ZIP code)
N
ASSESSOR USE ONLY
TRUE TAX
ASSESSED VALUE
-HOMESTEAD
NON - RESIDENTIAL;,
VALUE
AT.100% OFJTV
VALUE
--
1. VAL U E,
Land not exceeding 1 (one) acre immediately
VaNuation or 535.000
Signature of Auditor
surrounding residential improvements.
(1)
Other land
(2)
Total land (fine I plus line 2)
(3)
Residential improvements or Annually
Dwelling
(4)
Assessed Mobile / Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (fine 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
- STANDARD. DEDUCTION ALLOWANCE
20 20
Pay —
Lesser of 112 Homestead
VaNuation or 535.000
Signature of Auditor
Date signed