HomeMy WebLinkAboutHomestead_Riddle (2)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 IRS 14-03)
Prescribed by Me Department of Local Government Finance
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FEB 1 4 2006
I (we) YL 4E:t� d —/`f " iT /QiQilC certify �p�Gr1[Ij C a of March, 20
I (We) occupied as our principal place of residence the following described real property for which a Homestead Property ax ��.2211rJJe�ii X ISM WiRMmed:
P<I (We) owned ❑ Are buying under contract
il Have 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.
ONTRACTRECORDEDs'^S;iz..Y`
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
MO-P.ERTY:CESCRIPTIUN �'`c''=Y`f w' , '•''_ "x i..�.v = age ' ^. u" � .y- r, ?.
Court r
Township
Township
Tadn u (" , I , tow
/J5
Si ature of cl pant
Address (number and street, city, state, ZIP code)
Parcel number
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rAT 700, /e.OFj "TTV
Is the re in uestion:
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Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
/n�
N/�
Real property Mobile Homo (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1 i acre th
immediatety wmounds That s hictirre is used W produce income, describe the use and portion
of the property ublized to produce income.
(2)
n .,
20 _ Pay 20 _
Lesser of 112 Homestead
Vauaaon or 535.000
of Auditor
S
ROP,ERTX OWNED E1Y CLAIMAHT,IWbTHERCOUNTIES rc�%Qi '
County
Township
County Township
hereby certify the above statements are true, correct and complete.
Si ature of cl pant
Address (number and street, city, state, ZIP code)
�id r
iASSESSOR USE ONLY m
» _ "T{,yVAL.UE�h
TRUETAX�' +- 's�'ASSESSEDVALUE'�'HOMESTEAD
e,'✓ =,
rAT 700, /e.OFj "TTV
,w
yVy;V/1LUEf
h` 3-`a
NON �itESIUENTUILyP.
�a. VALUES -�
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)'-'Fe
y
Otherland
(2)
.ms�r�c
Total land (line 1 plus line 2)
(3)
Residential Improvements or Annually
Attaesead Mobile / Manufaclured Hone
Dwelling
Garage
(4)''�"/
(5)
T'y i? M0
e"
� r s4
308 -;$" 3 x
a
Other improvements
(6)
�y7 na
'� ,
-r ��*r3
Total improvements (fine 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(6)
1 hereby certify the above is We, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
Vauaaon or 535.000
of Auditor
S