HomeMy WebLinkAboutHomestead_Riley (4)N il CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
♦ / Stale Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for h1inq instructions.
MAR 1 5 2005
Md=upiedCERTIFICATI N TATEMENT'. I (We) I (We) s our principal place of residence the following described real propert ( which a Homestead Property Tax Credit is hereby claimed:
❑ I (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.
' ' "' - - .. s: .. - "�' ..1" CONTRACT!RECORDED " : � `. � � ,�< '... .•�. -:.. ,
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
_ ?'- .r* -. -- -- 3• i°`•`n `-�r '.-
PROPERTY DESCRIPTION �T• •T'•
County
Township
NON- RESIDENTIAI:�
Taring district (city town, township)
P I n ber
L es ion
: ' VALUE
Is the property in question:
Land not exceeding 1 (one) acre immediately
❑ Real property ❑ Mobile Homo (I.C. 61.14)
If any portion of the residential structure or the land not exceeding one (1)
acre roar immediately mounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
County
Township
County
S lure of
claimant
I hereby certify the above statements are true, correct and complete. �
Address (number and street. cit cfam ZIP code) l 4
Township
- -
ASSESSOR USE ONLY
TRUE TAX
.,TRUE
ASSESSED VALUE
HOMESTEAD
NON- RESIDENTIAI:�
- _
-
,
AT 100% OF.TTV-
: ' VALUE
- , =VALUE_,: ":
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
I (3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(6)
Other improvements
(6)
Trial improvements (line 4 through line 5)
(y)
Total value (line 3 pits line n
I (6)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Vedtying action - Signature of Auditor
Date signed
•:> ", S.fi - ?- t -- - -. STANDARD. DEDUCTION ALLOWANCE '
20 Pay 20_
Lesser of 112 Homestead
$
vauauon or 535.000
Signature of Auditor -
Date signed