HomeMy WebLinkAboutHomestead_Riley (2)�`"'" CLAIM FOR HOMESTEAD PROPERTY TAX
d°. b STANDARD/SUPPLEMENTAL DEDUCTION
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Stace Fortn 5473 (R12 / 6-09)
�O �° Preuri6ed by the Departmenl of Local Govemment Fnence
INSTRUCTIONS: See reverse side lor filinn instmctions.
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g� RM YEAR
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AUG 1 3 2009
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�q�Q v
I (VJe) �' c�rmy��{ ���p'��F�jFjour) prindpal
place of residence or am buying the tollowing desttibed real property for which omestead PropeAy Tax Standard Deduclion is hereby daimed
under conVact on the dat is applira6on is filed, (date of filing):
e) own ❑ Am (are) buying under recorded wnVact
Am (are) enfitled to occupy as a tenant-srockholder of a cooperaGve housing corporetion
� Have a benefidal interest in the Wst or the right to occupy Ihe property under the [erms of a qualified personal residence Wst
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If buying m con�aU, Fee Simple ownels rame '
Remrders office where conUad is recordeC Recad number Page
. . � • • � • •
�nry TownshiP Taring distrid (ciy, town, township) .
Parcel number Legal dewiption Is Ih property in pueslion:
6" �' '0.y � 'Q 1 pfopeny ❑ MnuaOy assessetl mobile home (IC 67.1-n
�If any portion of the residential sWCWre or Ne IanO nol exreeding ane 1) aae lhat immeCiatety surtountls ihat swmre is useE m pmduce Incame, Oescnbe che use and portion
of Ne p�operty utif¢ed 10 pmEUCe inmme. � j
� 0 3 ( O S � .� �.�-�i
�.� . .: . .
Coumy Twmship Caunry Township
i hefeby certify the above Statemenis are We, correU and complete. SignWure of dai , � '
Il
Ap�reu (numDer antl� �f. tiry, s(ate, antl LPcode � PQ S� N� /C �'v 4 h S � —! 7b �
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Land not ezceeding 1(one) acre Immediatety �"�{� r„'}..=�� �+` ��-� fi`�"�'.�-
sumountlin residential im rovements. ��� = ���-� �•_� 7 -�� �`�� %
�3_�;.tiwY- ...
+�,,.. ,..� �.�ik.<�, .�
O�her land (2) �'`:--.'^.::s;:.a„r:,: ��_-
7otal land Qine f plus line � (3)
�t^ !'•: ce ,,r
Residential impmvements or Mnualty ����� 4 � j�+t � 5.� �'� �- ,�.y. f� y^
9 ( ) 'c. c�_ �� r. Fw3
Assessed Mobile 1 Manufacturetl Home '� Y�' �'Y �� '"r ��
Garege (5) �-w'•,»�:i 0'+���r'.3:,. �i�s�r.,,i
W ' ,��� .. y. ..
Otherimprovemenis (6) .rya� �.� �;
Total improvements (Ilne 4 NrougA line bj (7)
Total value (line 3 pl�s Ilne n (B)
I hereby certity the above is [rue, cortect, Signatura atnssessor Date signed (month, day, yea�
and complete.
Veifyng action - SigruN(e of Audi[or Date signed (monN, dey, yea�
� . - � • � • �
20 pay 2q _ Lesser of 60% of ihe assessed value of ihe homestead or $45,000
NMrithstand'ug any atherpro�nsion, Ihe sum ol fha tletluctions proNded in IC 61.1-11 ta a mobde home Nat is g
rwt assessed as reel property a lo e manNadured hrnie fhet is not assessed as real properry meY rwt exceed
one-hatl (72� o/ the assessetl rdlue o/ fhe rtq0➢e fama wmenNacNied hortie.
Sigruwre of Puditw Date signeE (monfi. tlaY Y�A