HomeMy WebLinkAboutHomestead_Montgomery STATE FORM 53569 Bt3/7Y9) MEASURER FORM TS-IA
AFFRONT°BY STATE BOARD OF AROLITS,2209 PRESCRIBED BY THE DEPARTMENT Cr LOCAL OOVEA1a`ff T FTNAI.IM IC 6-1.1.2221
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)
State Parcel Number - G
26_o 2 - z9 - zoo -o06 Z2_ 9 -oi FIL BD
JAN 14 2015
PART 2:TAXPAYER INFORMATION
Owner I First Middle 1 COUNTY AUDITSR
/fie nn e�"� IY)C/7 . a , - /
Mailing Address(number and street,city,state,and ZIP code) n Same as property dr.'ress
Spouse First Middle Last
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)
soar
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 'Sighature Date
Y CLAIM FOR HOMESTEAD PROPERTY TAX
it CREDIT /STANDARD DEDUCTION
. + State Form 5473 (R2 / 5 -92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
GERTIFICATtgN STATEMENT - "`'`' - •:..
I (We) _ certify that on the 1st day of March, 19
1 (We) occupied ag our principal place of residence the following describ real property foohich a Homestead Property Tax Credit is hereby ly;claimed:
l ] 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 propijor )y
is lluyng under a contract.
- - ... CONTRACT RECORDED /['
'
It buying on contract, Fee Simple owner's name /
_ i _ j [� J
Recorder's office where contract is recorded 'Recmrdnt; fxr I Page
PROPERTY DESCRIPTION -
County
Township Taxing district (city, town, township)
P r I number
-
Legal description
5
If any portion of the residential structure or the land not ezce one (1) acre that immediately surrounds that strut. re is used to roduce into e, describe the use and portion
of the property utilized to produce income.
ASSESSOR USE ONLY -
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL.
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
,e
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
`
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(g)
hereby certify the above is true. correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE- -
r
19 Pay 19
Lesser of 1/2 Homestead
Valuation or $2,000 S
Signature of Auditor Date signed