Homestead_Riley (5)CLAIM FOR HOMESTEAD PROPERTY'TAX FORM
i CREDIT /STANDARD DEDUCTION HC7o
State Form 5473 (R2/5-92)
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INSTRUCTIONS: See reverse side for filing instructions.
YEAR
CERTIFICATION STATEMENT - -
I 'We) _ _ "oontract
certifydhat on the 1 st day of March, 19
occupied as our principal place of re foil described real property for which a Homestead Property Tax Credit is hereby claimed:
J I (We) owned ❑ Are buying u
❑ Have a beneficial interest in the ent ity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACT RECORDED _
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing distric ' . 1 vn, ripw )
-el ber O O� I _0 oLegal description
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. describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Townshi
0 aby certify the above statements are true, correct and complete. Signature of claimant
QJ tom.
Address (number and street. city state, ZIP code)
ASSESSOR USE ONLY -
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL.
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
-
Otherland
(2) '
Total land (line 1 plus line Z)
(3)
I
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pUs line 7)
(g)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
_Vo , ing action- Signature of Auditor
0'
Date signed
STANDARD DEDUCTION ALLOWANCE
19 _Pay 19_
Lesser of 1/2 Homestead
S
Valuation or $2,000
Signature of Auditor
Oat ed /