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Homestead_Brown STATE.STATE FORM 55569(0:11-09) MEASURER awaiTSIA APPROVED BY STATE BOARD OF ACCOUNTS.MS PRESCRIBED BY TUE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 10641.1_'s t IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS Lidividuals 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) 30 E V 1/40/n 4 274 State Parcel Number 9(0— la— t \- DAo o - 00 I. 33t-0O9 PART 2:TAXPAYER INFORMATION ///�//Q�� Owne First /\ Middle Last �" I Lazt Mailing Addre -(number and street,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) Driversss�Liic�ense/State ID Number (last 5 digits) Other(please specify in Part 1 below) state„D"\ , 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 Date INSTRUCTIONS erA, CLAIM FOR HOMESTEAD • PROPERTY TAX CREDIT /STANDARD DEDUCTION State Form 5473 (R2/1 -90) INSTRUCTIONS: See reverse side for filing instructions. CERTIFICATION STATEMENT (We) r - that on the 9 st day of March , 19 I (We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed: I (We) owned El Are buying under contract El property a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying it under a contract. CONTRACT ..RECORDED If buying on contract. Fee Simple Owner's Name Recorder's office where contract is recorded Record Number Page PROPERTY DESCRIPTION Taxing District (City, town; township): . Parcel Number Legal Description ^t 00 – 33/ –O (� If any portion of the residential structure or the land not ex a ding one (1), acre that immediately surrounds that struc- ture is used to produce income describe the use and portion of the property utilized to produce income. PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES ASSESSOR USE ONLY TRUE TAX VALUE_ ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE Land not exceeding 1 (one) acre immediately surrounding residential improvements Other land Total land - line (1) plus line (2) -Residential improvements - - Dwelling Garage Other improvements Total improvements - line (4) through line (6) Total value - line (3) plus line (7) (1) 1991 Pay 1992 19 —Pay 19 — Lesser of 112 Homestead (2) Lesser of 1/2 Homestead Lesser of 112 Homestead Valuation or $2,500 (3) Valuation or $1,500 Valuation or $1,500 (4) - - - - •- Signature of Auditor (5) (6) (7) (8) I hereby certify the above is true, correct, and complete Signature of Assesor Date Signed Verifying Action - Signature of Auditor Date Signed STANDARD DEDUCTION ALLOWANCE 1989 Pay 1990 1990 Pay 1991 1991 Pay 1992 19 —Pay 19 — Lesser of 112 Homestead Lesser of 112 Homestead Lesser of 1/2 Homestead Lesser of 112 Homestead Valuation or $2,500 Valuation or $2,000 Valuation or $1,500 Valuation or $1,500 Signature of Auditor Date Signed, -y'