HomeMy WebLinkAboutHomestead_Rileyd
R1
e� TM CLAIM FOR HOMESTEAD PROPERTY TAX FORM:
CREDIT /STANDARD DEDUCTION i�. HC101
. State Form 5473 (R215 -92) J �uU4
sie r JJ
INSTRUCTIONS: See reverse side for filing instructions.
YEAR
r n n
CERTIFICATION STATEMENT
1 (We) �V F/llln lX C 1:J usry�.�,� "�, )1.,�xtL.�{i certify that on the 1st day of March, 19_
�e) occupied as our mcipal place of residence the following described real ropeny for which a Homestead Property Tax Credit is hereby claimed:
LJ
l(We)owned ❑ Are buying under contract -
❑ 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.
CONTRACT RECORDED
II buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township -
Taxing district (city, town, township)
Parcel number
0 lb _W _0D
Legal description
r
If any portion of the residential structure or the land not exceeding one (1) aae that immediately s unds that structure is used to produce income, describe the use and portion
of the properly utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
ereby certify the above statements are true, correct and complete.
�igh� lure of claimant
Address (number and street city, state, ZIP code)
A
W
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON-RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
Signature of Auditor
Other land
(2)
'signed
Total land (line 1 plus line Z)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(g)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
-if yirg action - Signature of Auditor
Date signed
- STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 1/2 Homestead
S
Valuation or $2,000
Signature of Auditor
Date
,
'signed