HomeMy WebLinkAboutHomestead_EchertCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC1D
State Form 5473 (R6 14-M)
Prescribed by the Department of Local Government Finance F1
INSTRUCTIONS: See reverse side /nr /ilinn inctn,rtinnc
I (We) W W 1--- (.� rti- A " 1stcIty-d aarch, 20
I (We) occupied as our prin 1 place of residence the following described real property for which a ofoestead PiOpEMj`Ta£CieB(tfrs hereby claimed:
❑ I (We) owned ❑ Are buying under contract
ph 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.
NTRACT ;RECORDEDFL'a.`":u`','.r- #.',n`
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
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"a:.s�._.PROPERTY,DESCRIPT(ON .;:>`s.s cam°. "r t_`�x�a `•tl- 4 t`fii$ ';a �.Pr`
Court
Tawnship
,Address (number and street, city, state, ZIP code)
( A-) l< S i / u/3 S/XQ i
Taring district (city, town, t hip)
Pa �J �
Legal de
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question/�^
Real property ❑ Mobile Home (I.C. 6f.1 -7)
If arty portion of the residential structure or the land not exceeding oV 1) acre that immediately surru nds t structure is used to produce income, describe the use and portion
of the property utilized to produce income.
FUWW`5'W_ �s "'"' a *MrPROP,EkM`CIWNEIY: CLAIMANT -IN,'OTHER`COUNTIES`E''°,�
County Township
County Township
I hereby certify the above statements are We, correct and complete.
i atu of daimant
,Address (number and street, city, state, ZIP code)
( A-) l< S i / u/3 S/XQ i
r ASSES OR USE ONLY _�-
.t2_ai$.7#1,t�bsc4r-'
' ;TRUETAXY
�'V/1CUY
ASSESSED VALUE
aAT.t100 %'OFD "TfVVAL'U
HOMESTEA!
-.E:
NON== REStOENT1AL
fYd��`^�:VALUE,7, #a
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
„F4
Other land
(2)
r
SEEK,
Total land (line 1 plus line 2)
(3)
Residential improvements or Annua6y
Assessed Mobile I Manufactured Home
Dwelling
Garage
(4)
(5)
s ,;tt :x a
- sum -. �
_
Other improvements
(6)
y'. _ =-mss
u: 101 _
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
t � ; ' M�° ?F K4 0-' y- ,'�STANDAR�:DEDUCTION'ALCOWANCE
20 _ Pay 20 _
Lesser of 1A2 Homestead
Taw or 535.000 $
Signal r o nor Date signed
PA )WOxW
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STATE FORM 51569(R2 I]AI) TREASURER WA IS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,:VA PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC 6- -7:4 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 ZIP code)
30 el ft/ U.:,c S% -/C ff°mAcfi,,d? f-i/ t'7,- ? q
State Parcel Number
FILED
X6 ' /9- 3/- 3o/-coo. /97-ooy
OCCjTp�22 2013
_ . . ..T Y AUDITOR
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
— 2 y /Ore Eci..r-
Mailing Address(number and street,city,state,and ZIP code) n Same as property address
O(,f Al 7fie . 7- #
Middle Last
Mailing Address(Number and street,city,state,and ZIP code) [1 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)
State
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
•
\ )
PART 4:ADDITIONAL INFORMATION
INSTRUCTIONS
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