Homestead_Burton (2) •
11, CLAIM FOR HOMESTEAD PROPERTY TAX • FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION
State Form 5473(R12/6-09) HOl D
Prescribed by the Department of Local Government Finance. ) 7 I ED
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INSTRUCTIONS:See reverse side for Wing instructions. •
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CERTIFICATION STATEMENT
. I.,
I(We) _ , I I - IFFItt tM,Irit .I certify that I(we)occupied as my(our)principal
place of residence 4 am(.d buying the following des A.-• real property for which a Homestead Property Tax Standa educti i by->ySimed
uncle ntract on the date this application is filed, (date of filing): GIBBON COUNTY AUDITOR
I(We)own ❑ Am(are)buying under recorded contract
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
CLAIMANT'S INFORMATION
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
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Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
P number • Legal desert Is the property in question:
a6 1 -1$—Sop—D p j. 31- .❑Real property ❑ Annually assessed motile home(IC 6-1.1-7)
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.
atoa° rer. � 9o/v lye
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
I hereby certify the above statements are true,correct and complete. •of`U' i, Q .
Address(number and street,city,state,and ZIP code)
ASSESSOR USE ONLY TRUE TAX VALUE l ASSESSED VALUE HOMESTEAD NON-RESIDENTIAL
AT 100%OF TTV VALUE VALUE
Land not exceeding 1(one)acre immediately surrounding residential improvements. (1) "eaT di C • Zfr%4-2 TAW;.:.s
Other land (2) rfa
Iu141 •
Total land(line 1 plus line 2) (3) •
Residential improvements or Annually Dwelling (4)
Assnswd Mobile I Manufactured Home Garage is,�A i3t"'S
0 (5) �•r. z:3a mJ s �'�T �€sS
Other improvements (6) y3�1`%Jei R Dio,—t■
Total Improvement(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8) l
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying a ton-Signature of Auditor Date signed(month,day,year)
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STANDARD DEDUCTION ALLOWANCE
20 pay 20 Leccwr of 60%of the acc•esed value of the homestead or$45,000 1�
Notwithstanding any other provision,the sum of the deductions provided in IC 8-1.1-12 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-hall(12)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)