HomeMy WebLinkAboutHomestead_RileyFORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 i
y/�� SEE BACK FO FILING INSTRUCTIONS cot. 4007(01 -0m
' *(We) -, ` + certify that on the 1st day of
larch, -1-9-7-Y-1- (We) cupied as our principal place of residence a following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial inter}gs�I in the taxpayer
Property Description in County
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name uee simme
Township
or legal description shown on tax statement:
..56 "/y .5 E% L -3- Y /. %� (—,4,
Contract recorded in Recorders Office - Record No
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
Any other counties in which individual owns or is buying real property:
I hereby certify the above statement is true, correct and complete.
street
County Township
and Zip Cone
Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1 (one) acre immediately
surrounding residential improvem �T L r
Other Land nj
Total Land 1991
Residential Improvements MAR 3� Dwelling
r%Up1i0RTo
Other Improvements
Total Improvements - Line (6) plus (7) equals (8)
1 IFy certify the above is true. correct, and complete.
V V
Signature of Assessor
True Cash
Value
(1)
(2) �fo
(3)
(4)
(5)
(6) lG Sd
(7) O
(8) �o
/81.70
- ACTION BY AUDITOR -
Assessed
Valuation
/7o
- A-B -a-o
—g / f0
2 I
Date
Approved: Date:
Homestead
Valuation
70
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tTATE FOAM!lta tILrf WI TRIASritIR tuned lfIA
.ArrfT'Et aY,TATEb∎AD0FAM1Ya'.T(-ltn PLMIUDIDTY the OEtMT\O.YTCF lrkill Css..TIONMT FINANCE Ir LI.I-2NIA
01 N Main n County Auditor
1 IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N
PRINCETON IN 47670 Individuals and married couplet arc limited to one homestead standard deduction.As the receipt of this deduction bttrontes
more beneicial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tat bills for all:therefore.
® HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This informaiion will he Let contideniial and am only he accessed by authorized county officials.The Ikpanment of
Local Government Finance will use this information to create tools that will h:Ip county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Riley&Son Farms Inc
RI Box 328 A
Francisco IN 47649
—8535 --- — - _- - - - - - - - -- -- — . — — - --
Riley&Son Farms Inc
6328 E 550 S State Parcel Number Lesal Description
Francisco IN 47649-9138
1r1n11nr1r11ru1n11r1n1t1u urIluilrinlu rlF�1u1r1t1tr1 26-20-06-400-000.862-001 001-00862-00 SE SE 6-3-91.945 AC
PART 2:TAXPAYER INFORMATION
Owner I First 00 Middle / Last
fie) N Da vial ie!—! e� — —
g Address(number and meet.city,state,and ZIP code) Same as property dress
63x8 P 5 _cam s
Spouse /V • First Middle Last
Mailing Address(Number and sTree4 city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivels License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
sox
PART 3:CERTIFICATION
Each undersigned certifies,under penalty of perjury.that the above and foregoing information is true and correct and that he or she is eligible to
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Signature Date
PART 4:ADDITIONAL INFORMATION