Homestead_Braselton STATE FORM 53,69 IR:/ial) TREASURER FDRM TS-IA
APPROVED BY STATE BOARD CIF ACCOUNTS.:W9 PRESCRIBED BY THE RPABTMF•T OF LOCAL ra'ERNat:r flSAtit 061.1_-51
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(n r and street,city,state,.Bnd ZIP code)
M zata,a0,1 OA 5 Ct°n
State Parcel Number
2 & , 9 — �9 /O / 896 6 c FILED-.
SEP 2 52013
PART 2:TAXPAYER INFORMATION - _ _
Owner I First Middle n n Last
aid Mailing Address(number and street,city,state,and ZIP code) Was property address
-.
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) ❑ 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)
Rate
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 Dye
•
•
INSTRUCTIONS -
,W\ P &5•
ej^�
, g CLAIM FOR HOMESTEAD PROPERTY TAX
���� CREDIT/STANDARD DEDUCTION
� Sta�e Porm Sa73 (R2 / 5-92)
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�eiT
INSTRUCTIONS: See reverse side (or tiling inst�uctions.
FORM
HC10
�
� �Ne) ��,1.AN�- (f � / ' � I ��� �/VU �— � � certify. that on ihe 7 si day of March. 79_
—T g
ii) o ied as our principal place of residence the following described real property for which a Homestead �T Cr i � claimed:
I—' (We) owned ❑ � Are buying under contrac4. , - . � . �- �s��
❑ Have a beneficial interest in the entiry that is liable for the pmperty taxes oathe property and that owns ihe proA�ori+� $uyy�u�nder a contraa.
- CONTRACTRECORDED
Ii buying on contraa, Fee Simple owner's name
Recorder's oHice where crontract is recorded
C�n,•'u C�Unirv 4UDI70R '
Record number Pa9e
� . � � " PROPERTY DESCRIPTIO � �
COUnry . '' . Tovmship � Tauing di c -y.� n. to M - ..
rP�ce' mhe,y� � ^� O Leqal descrip�ion
`� U
If any ponion of the residential s(rucmre or the land not exceetling one (11 acre ihat immediatey surrounds that structure is used to produce income, describe the use and portion
oi the pmperty utilized to protluce inwme. , .
County
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
certify the above statements are irue, correct and complete.
number arrd street ciry, stafe. ZIP code)
n � ! / I . � _ / . /✓ ?
Gaimani
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL �
.VALUE VALUE� VALUE VALUE
Land noi ezceeding 7(one) acre immediately
surrounding residential impmvements. (�) �
Oiherland (2) ,
Total land Qine 7 plus line 2� � (3�
Dwelling (4) � �
Residential improvements .
� Garage (g) �
Other improvements (6)
Total improvemenis (line 4 through lina � (7)
Total value (line 3 p�s line n (g)
I hereby Certi}y the above is lrue, correcl, and Sgnamre ot Assessor Date signed
complete.
�tying aciion - SignaNre ot Audiror � Date signed .
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