Homestead_Johnson (5)CLAIM FOR HOMESTEAD PROPERTY TAX �tt�Q� FORM
CREDIT /STANDARD DEDUCTION \ HCto
State Form 5473 (R614.03) lT
Prescribed by the Department of Local Government Finance n ,
m d:
L_y,/ GIBBON COl - &
I (We) owned ❑ Are buying under co t
rhHave 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.
::i.'- 1�t'- 'i�3v?" 'S` t- ..�= �.ktr'�'; ,f°uzr '""a3�. - .`0.''{€�n` Ra•°a'rl r mss." �- CONTRACT,RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
.-�0.r fVW1 -ee kW -- -i P.ROP,ERTVDESCRIP,TION
-:r .t- ,.,,
Township
County
Township
Taxing d t 'ty, town o ip)
ParcVl np1 tu
Leg cription
Is the property i uestion:
-be
0 ; L Q
Real property ❑ Mobile Home (I.C. 1.1 -7)
it any portion of the residential structure or the land not exce cre that immediately surrounds that structure is used to produce income, describe the use and potion
of the property utilized to produce income. Cut / O71
4= d.VALUErs
P,RO ONE RTY,OWNED';BV CLAIMANT:IN' OTHER "COUNTIES a µ: j'` Z
County
Township
County Township
I hereby certify the above statements are We, correct and complete.
Si nature o imant
C
an (number and street, cit)6 state, ZIP code)
ax3"r�=t,
#ASSESSOR USE ONLY n4
-TRUE TAX "Ys
ASSESSEDVALUE
`''xsHDMESTEAD
NON?RESIDENTIAL �f
k:5.fd:`-
vauaaon or $35.000
VALME
%OF'T7V
-
;.,
zx' ;
.:ATk100
,VALUE
4= d.VALUErs
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
., .r....
Other land
(2 )
�
F
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
-'ro
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Gara g e
- --
(5)
3 r 79
Other improvements
(6)
rR`'_i
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
s« r' '� T1,';= STANDARD:DEDUCTIOWALGOWANCE
20 _ Pay 20
Lesser of 1f2 Homestead
vauaaon or $35.000
r f ditor
Date signed
j"
01 1