Homestead_Dunn (13)eaFSCammor�
Individuals and married couples are limited to one homestead standard deduction. As the recei�
deduction becomes more beneficial, there is more incenti�•e than e��er for homestead fraud. Ho�
�fraud causes higher tax bills for all; therefore, HEA 1344-2009 requires taspayers who recei�
homestead siandard deduction to ��erifV that they are eligible to receive the benefit and to pn
additional indentifying information necessary to allo�v county go��ernment to better monitor ho.
filings. This information ���ill be kept confidential and can only be accessed by authorized counh•
The Department of Local Government Finance �vill use this information to create tools that �r•i
count�� officials eliminate homestead fraud.
�rty Address (number and street, ciry, stare, and ZIP code)
a��� N C�
Parrel �umber
a�-o5- 33- �ia� � �
�`��—�
I ��n�
� Same as pmperry address
� rv �t7 c�� d
folease soecifi• in Part 3 below)
Each undersigned certifies, under penalry of perjury, that the abo��e and foregoing information is true and cortect 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 bacA tases and substantial financial penalties. I
��' �
: Signature
��b A. �.,,,...�
Dale lelephone
��_i�-�3 ( )
' CLAIM FOR HOMESTEAD P.ROPERTY TAX
° CREDIT/STANDARD DEDUCTION 1'a-
� State Fortn 5473 (R614-03) (—;1 �
' Resaibed by Ne Dapartrnem of Local Govemment Finance �\� `
� INSTRUCTIONSi See reverse side for filing instnm.lions.
�
FORM
HC10
•YEAR
� M�e) �,�-�--L�� � s� ��� � �•�
Homestead Property Tac Credit is hereby daimed:
�(We) owned ❑ Are buying under contraci
ave a beneficiat interest in the entiry that is liable for Ne property taues on Ne properry and that owns Ne property or is buying under a conVact.
��wS:2".�iiil�.li.<t'..>;�'.,°.. _-�_. :St:�T',.`.�.�..+>>::.t ,.,. . fn x�x`CONTRACT�RECORDED < . . . . � . .. -� . . .. _._.
. -...�.,,.._. .. _ � . . ,_ ,. _:.; . , �
If buying on contrecc, Fee Simple ownafs name
Recordels office where conVaa Is racorded . Record number Paga
Counry
Pamxinumber
- - _ .«'gs.rr:
Tavnship •.,
Lepal descriplion
Is the
If any portion ot Me residanlial structure w Ihe land not excaeding ona (7 ) aae that immediateN wrtounds Nat
of Na property utllized to produce income.
-c�.i -
Question:
�� D�Derty ❑ Mobila Home (LC. 67J-�
e is used to produce incame, descnbe tha usa and portion
� /�
� -?��"�`r�+��sl�"',..''%�b�.�$r.�.��n`bs:�.c�'�.#PROFERT.Ya�OWNED�BY._CI:AIMANT_IN''OTHER;COUNTIES?;"' �> ?-.-��ss�7 <_u:q'+�:���e��. :��'i..�.iF""'
Counry Twvnship County �Tavnshlp
I hereby certify the above statemenis are true, correct and complete. Signa[ure oi daimam
— � ���
(number end sUaef, ciry, sfata, 21P oode) -
6L�t.3 � � � <x �v y 1 �10
a�;"i"�'�' r'�{'"�'�"�'`�"'��`"'�'{''�'�ris;:a�°>�' "3'TIiUE.-TAX+'� r ASSESSED�VALUE HOMESTEAD ''A` �NON RESIDENTIAL'°"
w��..�`gy� �AS3ESSOR USE��ONLYJa."�� �2.+�'. S wr,'�VALUE^--`L� AT>100%OF T7Y� z4z- _- VALUE ".', � r,'. �� �{ '� �:VALUE �� j. ;��
�2._.3°`.�...�siN..'.�2tcP.Lr� �n _R�}fnaT�'1+_e.fY_nf+<'3 5. ..._bstl ✓ --.e �._ ..r„ .ri .
Land not exceeding 1(one) ecre immediatety V �?c ` -` 4 ° -�-'!` '•'
surrounding residential improvements. ��� ' �`r�' p`�'�>, _, r,`' r��:=
-= qY _
Otherland �y� -
Tctal land (Ilne 1 plus line 2) �3� �
„ t ;a. . .; � ,..
ResidentialimprovementsorAnnualry �elling (4) �`�,t r p ;:.,_ Y �- ;�.
Assessed Mobiie / Manufaclurad Home � � - -
Garage (5) ;.4-:�°��r ; ..
O�berimprovements (6) ' '����"•�'��' =�
Tdal improvemen4s (line 4 through liire 6) (7� .
' value (fine 3 pf,s line � . (g�
I nereby certity the above is W e, correct and � Signaw�e at Assassw Daca sipned
complete. �.
Veifying e Won - SlgnaNra otAuditor Data signed
� ��"a`'i �`+:`;t2<�- �'�..i . � ? . n�:_° ��,.`STANDARD�DEDUCTION`ALLOWANCE� .
20 _ Pay 20 _
Lesser of 12 Homestead
Valuation w $35,000 �
Signatura of Puditor Date signed