HomeMy WebLinkAboutHomestead_RikerCLAIM FOR HOMESTEAD PROPERTY TAX
CREDMSTANDARD DEDUCTION
State Fpm 5473 (R614.03)
Prescribed by the Department of Local Dovernment Finartce
INSTRUCTIONS: See ram= abe for fi ft 6rebucbw a.
V00 FORM YEAR
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FIVPr)
1 (We) n a> Q e _ SEP 2 6 7nn�
� o certify that on the 1st day of fAdfcfi! 20
(We) occupied as our principal of residence the followi described real property for which a Homestead PropertyTax Credit is hereby claimed:
I (We) owned ❑ Are buying under contract �l
5 Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prope4 ar Is'btfl SgTuBdeUzDmf�tfact.
ixaCONTRACT�RECORDED
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
_
County
Tmnship
Testing disuict city, town, township)
Parcel number
Legal d d n
Is the gro pe in uestion:
is
`)
property ❑ Mobile Homo (LC. 61.7 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, descdbe the use and portion
of thn property utfirzed to produce income.
• "ic�+��-r_?`PROP,ERTY, OWN ED`.BY CLAIMANT,IN' OTHER "COUNTIES,t..�.�,cr- r!`yp.
County Tmnship
County Township
1 hereby certify the above statements are true, correct and complete.
Si nature t claimant
n dress (number and street city, state, ZIP code)
r I i o
*`T'``'om z
- F- fASSES50RUSE ONLY• -r�
TRUETAX rk
r'�t' >
i§.
SASS SEDVALUE
i/1T 100%OFdTTVg
''HOMESTEAD•r
a
WALLIES' .'
)`Y sA"NON= RESIDENTIAL 5
}
��`` -I VALUE'j S--s_
ro. -
Land not exceeding 1 (one) acre immediately
/r��^
surrounding residential improvements.
Other land
(2)i'r
z' =i
Total land (line 1 plus line 2)
(3)
Dwelling
(4)r"
'Residential Improvements or Annually'
^ ^"�°'4
Aseassed MobW I Manufactured Homo
Garage
g
IS)
4r
20-1-6
Other improvements
(6)
0V, sRR%;
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
valuation or 535.000
Date