HomeMy WebLinkAboutHomestead_Campbell (3) STATE RAM 535M(IC I:M TREASURER FORM TSIA
APPROVED By STATE BOARD OF ACCOUNTS,X135 PRESCRIBED BY THE nEPARTMLYr OF UICAL OOTh>¢AT F I N A N C E r 6 4 I-2 2-0 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)
760 3 LITIC r oJH / t (15ronch 1 IV iv 71.° )/ i
State Parcel Number
a1 — / 9 - / 9 - /6 / - oo0 F7l -Oaio
PART 2:TAXPAYER INFORMATION .
Owner I First Middle Last
A- /e.x K Com/0 ,3e P
Mailing Address(number and street,city,state,and ZIP code) El Same as prop rty address
SGU a / Inlco/A / rt rgnc4 Ati �`176y�'
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) I I 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 Signa Dace
PART 4:ADDITIONAL INFORMATION
INSTRUCTIONS
MV `P R- 5a
-1
f;>- ,, CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
( CREDIT/STANDARD DEDUCTION HC10 g•
State Fonn 5473(R8/7-07)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
CERTIFICATIONSTATEMENT - _. • :
I(We) � • �. . b �'• JLl _•_ , certify that,on the 1st day of March,20 .-
I gle)occupi as our . .ndpal place of res'.ence the foil. ng described real property for which a Homestead Property Tax Credit is hereby claimed:
•I(We)owned ❑ Are buying under contract
lave 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 owners name
Recorder's office where contract is recorded Record number Page
• . - .. PROPERTY DESCRIPTION- - _ - -
County Township Taxi�stn.a``ity.ttown.n.township I number Lege Option ^r ^- /n� - � I s the pr ny in question:
/BVt.4 V r•--.0-0, 11 ❑ Real property ❑ Mobile Home(IC 6-L f-7)
[(any portion of the residential structure or the land nneexceeding one(1)acre that imnjsdta[Lnfy surround that structure is used to produce income,describe the use and portion
of the property utilized to produce income. (\J
a- \ C- 1 Q- 10 -Cleo .$1 \ -c a
• - PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County f`1A Township
I hereby certify the above statements are true,correct and complete. Signawrel8t ant \U gy7���0`�`"(`J�1(\`
�ss(number and street city,state,and IJp code) (� )\IYUYhR , \ "\
"-700 5 jvq/ Lm-C�cY`/lY`� w0�lw -�\i
ASSESSORUSE ONLY - - I TRUE TAX VALUE ASSESSED VALUE I HOMESTEAD - NON-RESIDENTIAL
AT 100%OF TTV ! - .VALUE VALUE,.
Land not exceeding 1 (one)acre immediately surrounding residential improvements. (1)
Other land (2) '--
Trial land(line 1 plus fine 2) (3)
Dwelling (4) - - .
Residential improvements or Annually _
Assessed Mobile/Manufactured Home - -
Garage (5) A � 1 1 . / l• "
Other improvements (6) , y
Tcual improvements(line 4 through line 6) (7) / r` I ✓ -7 7____ ,L...
Trial value (line 3 pits line 7) (8)
I hereby certify the above is true,correct,and Signature of Assessor Date signed(month.day.year)
complete.
Veilying action-Signature of Auditor Date signed(month,day.year)
STANDARD DEDUCTION ALLOWANCE- _ - - --,-
[e_pay 20_ 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 12 44,000 for 2008 pay 2009 41.000 for 2011 pay 2012
Homestead Valuation $
or 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor Date signed(month,day.year)