Homestead_Patel STATE Rt1 ma an Men '
TRFAS'AEi MIN
6-J INA
AN'-.D.'It 34 STATMOAMOr ADMI,'FT{:aH eILEICRMIT ElY 1:EFAli r.pr LOCK OnnnanCn FLWrk F 6:.1.2.111
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 INFORMA'T'ION
Property Address(number and suet[,city,state,end ZIP code)
IC? 7171 tO loos Pir I 1/ csion t T�N 14-7 (a10
Stare Pr eel Number
ac - 1H I 0 — tea. '3 B " a7
PART 2:TAXPAYER INFORMATION
Owner ►harts Middle [D.
Mailing Address(number and sttet,civ,state,and ZIP code) ID Same as property address
9 `� lb 1005 Pr i nedori Try 47c9-70
First Middle Last
Mailing Address(Number and sleet,city,sate,and ZIP code) ❑ Same as property address
Socal Security Number(last 5 digits) Driver's L icense/State ED Number Cast 5 digits) Other(please specify in Part 4 below)
sot_
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 Si nature Date-
�
Spore Signature Date Telephone ( l
•
\ /
PART 4:ADDITIONAL INFORMATION
•