HomeMy WebLinkAboutHomestead_Riley (2)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION Hc10
State Form 5473 (R614-03)
Prescribed by the Department of I 1 GovemmeM Finanoe
INSTRUCTIONS: See navem ltitb lbr OV kichictiam
I (We) L that pn tlr )St.�y of March, 20
I (We) occupied as our principal place of residence the following a bed real property for which Hom ' Tax Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract C 2 a 2QQ5
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns ThEe property or is buying under a wntract.
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded
Record number I Page
F 1
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ASSESSOR E ONLY` <rr
_ _.-_ _— i@'
P,ROP,ERT`I.DESCRIP,TIONr.'. V!?s". �> .:�-� t -`
County
Tornship
Taring district (city, town, township)
P ben
L escription
a property in question:
Real property ❑ Mobile Homo (LC. 61. 1-7)
H any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income. describe the use and portion
of the property utilized to produce income.
F 1
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ASSESSOR E ONLY` <rr
TRUE TAX
County
Township
County Twvnship
I hereby certify the above statements are true, correct and complete.
Signatur of claimant n
O_`Y'
dress (number and stree te, ZIP code)
F 1
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ASSESSOR E ONLY` <rr
TRUE TAX
ASSESSEDVALUE
&HOMESTEAD
ENTUIL F,
�T;
Land not exceeding 1 (one) acre immediately
ti `"r ,7SsS`.
surrounding residential improvements.
(1)
�i'<',I,'',','Sn;?
Other land
(2)
Total land (line I plus line 2)
(3)
'Residential
Dwelling
(4)
"'k
'�al�s'+[2>;`."�.r"'.S1xa.:
Improvements or AnnuaOy�
Assessed Mobile I ManufaWued Home
Garage
y h
Other improvements
(6)
l r
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, coned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
Valuation or (35.000
Signature of Auditor