Homestead_Towner c
fi";r CLAIM FOR HOMESTEAD PROPERTY TAX FORM
YEAR
im 7 STANDARD/ SUPPLEMENTAL DEDUCTION OR
aJti a State Fonn 5473(R13/12-09) ,
Presnibed by the Department of Local Government Finance
11,' UCTIONS:See reverse side for filing instructions. 11.
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?r�-;i:�:t�ir�.n-'�-�..Y.`r-r s?J..u•fi..?a: �++�i:fe'�a�.[�.}r���'�3 CERTIF;ICATIONTATEMENT'L'-.«•F�i�a r,.,}�9�tt'r-.S=�j`x4 � t�x' r�'.k " �,.:.w
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I(We) S . ... • . E CS- p \ ii - ss a ea .a_ s, 1 at' ,ww my(our)principal
place of re.t-nce or am(am)buying the following described -`-I property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing). I(We): t,1oV 9 ZO\Z
Own ❑ Am(are)buying under recorded contract /'�
Am (are)entitled to occupy as atenant-stockholder of a cooperative housing corporation C. .
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal resigep OR •
❑ Am (are)the shareholder, partner or member of the entity that owns the property. GIBBON COUN
If buying on contract,Fee Simple owner's name
Recorders office where contract is recorded Record number Page
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a�i'.�:?l'-;.:,...._.�+tvt+ . :i-�+.. .-.7.�1V„.C::,„L.'h 11�.`.,,r`!PROERTY.OESCRIP.TION ,:ld{.{its,.._fstc l,r T`,+ . _-,.".—�..x1d..-' . �'�`f:,:4.._s
IllTownship Taring dis township)
Ill number Legal description Is the property in question:
a L, ? -/+3-a 0 c 00 is a O /0,R5 Real property ❑ Annually assessed mobile home(/c -7)
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.
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.r-�.�,r�?,,•�F-_,�_r,_ H,.,2:/•c�;ta��,�,D.,�,,,PROPERT.Y:OWNED'BY:CLAIMAhT,',IN,OTHER,COUNTIES{F�*y�1's�'K,;si--_,?� ,E,;;-•,,,.,,m *-Z+,.�'
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature fL 4,
Address(number and sheet,city state,and ZIP code)
00 : W -IA4e 'd /48 F4- B cnCh
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s.fiz tt , ASSSORUSEONLY¢ z WT XI TFLUE ITA%VALUE ' PT 00E OF 1/ I$2 VALUE Ii`2i r 'VALUEt- F
Land not exceeding 1(one)acre immediately Y ,^ r c
surrounding residential Improvements. (1) `_^ , CL4 , ' >-i,
Other land (2) j' hr--"g-V1/.
Total land(line 1 plus tine 2) (3)
Residential Improvements or Annually Dwelling (4) rAk 3E�' s. q,� Gi'#
Assessed Mobile I Manufactured Home Garage (5) ;;ice' -'fzk .a ri Ip �"Q Y
Other Improvements (6) V n :,: n z`'_:
Total Improvements(line 4 through line 6) (7)
0 value (line 3 pits line 7) (8)
I hereby certify the above Is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
1 ^tiJ.F4.s244-ik 1 s-ez,-vi= :r:S,Nt..:11-1aci'`.'4S TANDARD DEDUCTION"ALLOWANCE y 1136 9 ,'.12.14.`-LA , -_, f,7, iii?5�:+:±_ ((-(3;(1
w 20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000 O /
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that is $ „/
not assessed as real property or to a manufactured home that is not assessed as real property may not exceed — /-
one-had(12)of the assessed value of the mobile home or manufactured home. -` ..
tore of Auditor _ Date signed(month,day,year)
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