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Homestead_Riley (6)CLAIM FOR HOMESTEAD PROPERTY TAX j CREDIT /STANDARD DEDUCTION r State Farm 5473 (R215 -92) INSTRUCTIONS: See reverse side for filing instructions. FORM YEAR — HC10 = 1 nnnn RTIFICATION STATEMENT DD - �L �IF— I (We) V I - ce that on theVl st day of Ma/dh, t (We) occupied as our principal place of residence following describe r al property for which a Homestea opNrtyy� 'Credit {srhere _Dl! ad. _ ❑ 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. CONTRACT RECORDED It buying on contract, Fee Simple owners name Recorders office where contract is recorded Record number Page PROPERTY DESCRIPTION County Township 1 Taxing district (city, town, township) Parcel m r Q U Legal description f 3-3—V c— If any potion 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 COUNTRIES County Township County Township 7 er by certify the above statements are true, correct and complete. Sig ure of claimant ess (n tuber and street, city, state, ZIP code) 2 l l3QX ITS OciK�gnC�l c k ZNO. �I1�bASSESSOR rLa'n' USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL VALUE not exceeding 1 (one) acre immediately surrounding residential improvements. (1) Otherland (2) Total land (line 1 plus line 2) (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) (8) I hereby certify the above is true, correct, and complete. Signature of Assesor Date signed Verifying action - Signature of Auditor Date signed STANDARD DEDUCTION ALLOWANCE 19_ Pay 19 _ Lesser of 1/2 Homestead Valuation or 52,000 $ Signature of Auditor Date signed � -la -ems ...MOVED BY 14Th rw'1 MFD<MCE PORN r4.1 IMPORTANT NOTICE TO HOMESTEAD FP PROPERTY 0.OWNERS a BO.UtO Of ACTTPUNT5.Inn MY-1011ED BY 111E Gibaon County Auditor 101 N Main PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this dcdtnion becomes more beneficial.there is more incentive than ever for homesaead fetal.Homestead fraud causes higher tat bills for all:therefore. • HEA 13+3-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to revise the benefit and to provide additional identifying information necessary to allow county government to better monitor homestead filings.This information will he kept confidential and nsn only he aerecsed by authorized county officials.ls.The Department of Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud. PART 1: PROPERTY INFORMATION Taxpayer Name Property Address Riley, Neil L/ Mary H RI Box 174 Oakland City IN 47660 944 Neil L/Mary H Riley 9034E 550 S State Parcel Number Legal Description Oakland City IN 47660-8578 III I I I I I I III I I I I I I I I I I 26-20-03-400-001.816-001 001-01816-00 PT SW SE 3 3 9 2.00 AC t o ur r ru a nr u n r t nr a ur n n n r . / PART 2:TAXPAYER INFORMATION Owner I First Middle Last /`✓e,�/ i'L e y to Address(numbef and street.city;vie,and ZIP code] - — - - -- ' '— - -. 'N'Same us pruµrty tddna; - -- -' r70 31/ E 56 o S 0A/CIAu4 re-4y , 2N 9'x 6 6 Spouse First Middle Last jn y gelen eZe y Mailing Address and street.city,state,and ZIP code) LL ��qq J © Some as property address 463cL j . 56-0 S OAh/ANd� CrrT�f, 16t) 4/7660 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,SSignature Date •