HomeMy WebLinkAboutHomestead_Scales (2) STATE FORM 11f691a=/]d41 TREASURER FORM TSIA
APIROVEDBY STATE BOARD 4"ACCOUNT 5,:[W PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE F 61.1:.81
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
a toes -av - alviimirop /a 4t ill ED
NOV 142013
PART 2:TAXPAYER INFORMATION
Owner I ///I/1 First Middle BSON COUNTY M ' a Last
Mailing Address(number and re t,city,state,and ZIP code) n Same as property address
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)
stale
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.
Oangl-(Signature DateTelephone
PART 4:ADDITIONAL INFORMATION
INSTRUCTIONS •
. MVP
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fwm 5473 (R6 / 4-03)
Presfribed by Ne Department W Local Govemment Finance
INSTRUCTfONS: See reverse side for (ling instnxtions.
� FORM
HC10
� �����
ENT'�...�{3;e�?�- � . . _._. :`."-'E9tk'=3
�
1 ,J YEAR
�
e
I(VJe) � � certify Ihat on the 1st day of March, 20_
I(We) occupied as our principal p o residence the following descnbed real property for which a Homesie foperty Ta�c G"e�di� is hereby daimed:
���a ,�,+�
❑ I(We) owned ❑ Are ng under contract U
' Have a benefidal interest in the entiry fhat is liable for the property taxes on the property and that own�Bt�g prr6pgrtyNar�s��iy��i�4i�der a wntract.
if buyiig on conirad. Fee Simple owners name
Recorders ofice where conVaU is remrded
Counry
Tavnship
Tating Oistricl
Record number � Page
Parcelnum //` OD/� �¢g� �p / Isih pmperty' que5lion:
Ld f
l� /, Real Oroperty ❑ Mobile Homo (I.C. 67.7-7)
I( any portion of Ne resitlenUal sWCWre w the Wnd not xceeding one ) a e Nat i dia ty wr ounds that swaure is used b produce income, describe the use and portion
ot the properry uu7aed W produce fnmme.
�-p ���- �a -���oa -c�.ia�-oa�
"'�� ��`'"'� ���'''�'�� t+�, m��-� `+�.�.�"'TRUETA7(�`� ASSESSED`VALUE t- HOMESTEAD � NON RESfDENTIAL °'
��'^, m �ASSESSOR USE ONLY � � � � , �, � , ,.-, ��'
+"?.i:.. .�€�.��'-�._.s�-_ as;.l�T.�.axs`r_.:-."5*.�''-t��U�'i � YALUES--Ix...�`,,,. �_AT 100%OF�TTV� �VALUEn"w: �,�"�+T'�..-..:&.VALUE�,j�'"t..��-.."R.`�,
Land nol exceeding 1(one) aae immediatety �'�Y�` a 1-`"=� ..,; �?
surrounding residential improvemenLS. (�) .p -�' ���� <t ���,
':=� � ...- ., k,� Y
Other land (p) �'�`' ����
�:�5�. 'u�,:y-_,.
Tdal land (line 7 plus line 2) (g)
•�,�.� ���4�4��"�'�
Dwelling (4) r+ gy, r
�ResidentialimprovemenLSOrMnually #'���"'��'� �`'�
Pssessed Mobfle / ManufacNred Home Ga2ge (5� ..� s �.-.-'T�„-',���
�^��.
�s'�„�ant;� '. s.:Y;=c .. t �Ar.��`�'+.._
`_.'�� .�y��
Other impravements (6) ��'=`�>;`t�r��
'_%v:sa�'�F` �. w°.n
Total improvements (line 4 through line 6) (�)
Tdal value (line 3 phs line n (g�
I hereby certify the above is We, corred, and Signature ofASSessor Date signed
complete.
Veri(ying action - Signature of Autlimr Date syned
20 _ Pay 20 _
Lesserof 1/2 Homestead
vawanon w S35.00q
S
SignaWreofNidil� r I n�,�l�l� IDalasign �^��'O
�;