HomeMy WebLinkAboutHomestead_Murnahan R TREASURER FUFIrS1.1
ARMORED B YSTATE BOAJO(F ARTS.200. PRESCRIBED BY THE ffPARiETCi LOCAL fAVEIAT@rFflmARE
IC 6-1.1-214.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
1 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 and ZIP code)
State Parcel Number
Og - //—aff CIO ' 007 39g— 6102/
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
(4 62 ., i4,14(2 .La-Ac.)„Vita"
Mailing Address(number street,ci ,state,and ZIP code) U n Same as property address
3522 % Z CLi) 51J ,l/E . .1-194C
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) 0 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)
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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.
Cr I Signatur Date
II
INSTRUCTIONS
t n,3
e.�'� ; CLAIM FOR HOMESTEAD PROPERTY TAX
a��� CREDIT/STANDARD DEDUCTION ' .
� State Form 5<73 (R2 / 5-92)
�su
. INSTRUCTIONS: See reverse side /or tiling inshuctions.
� _ �
FORM
HC10
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�We) _ certify �hat on the 7st day of March, 79_
�9 occupied as our principal place of residence the following described real property r which,a Homesiead Property Tax Credit is hereby ciaimed:
[� i (We) owned .❑ Are buying under coniract . - . , , ,
❑ Have a beneticial interest in the eniity that is liable for the property tanes on the property and thai owns ihe property or is buying under a contract.
� CONTRACTRECORDED �
If buying on coniract: Fee Simple owner's name • � . � �
Recorder's oHice where comract is rewrded Rewrd number Page
County
Parcel numb.e�r`
-L.7 �Zs..?—L>—
If any portion of Ihe resid
of ;he propeny utilizetl to
Townsttip' '
description
PROPERTY DESCRIPTION �
. Taring disvict (ciry, fown.
stmcture or the lantl not exceeding one (1) aue
rce incame.
a�-�i- a�s- 3�-cb �
" � � 1�_Q
siruaure is used m produce
37�- Oaj
describe the use and portion
PROPERTV OWNED 8Y CLAIMANT IN OTHER COUNTIES
Caunry Township Counry Township
�eby cenify the above statements are true, correct and complete. Sign c r aima� `� n �.
I `�t
Atltlre �num r�d eet�Firy, state,. I cod¢}� n 1"�,�C �'' I n �, / j �(� (^_.�
F I V ..�i .J u�C N `�< <.�vlC
ASSESSOR USE ONLY TRUE TAX ASSESSED NOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately
surrounding residential improvemenis. (�)
Oiherland (p)
Total land (line 1 plus line � (3)
Dwelling (4) - �. . .
ftesidential improvemenis
Garage (5) • U
Other improvemenis �6) � �y*f-5
v
Total impmvements (line 4 Ihrough lina � (7)
Total value (line 3 pLs line 7� (g) ,
I hereby certi(y ihe above is tNe, correGt, and Signature of Assessor Date signed
complete.
mg action - Signawre oi Auditor � I Date signed
.�
19_Pay19_
Lesser of 7/2 Homestead
Valuation or 52.000
STANDARD DEDUCTION
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Signamre o� Auditor Date signetl
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