HomeMy WebLinkAboutHomestead_Penner (6) ZeCLAIM FOR HOMESTEAD PROPERTY TAX FORM I YEAR
1 STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473(R13/12-09) HC10
,r„ Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing'instructions. ;.!
�p - - CERTIFICATION STATEMENT _ - .
I(We) op - r r A.A • certify tha3 )prxxl s my(our)principal
place of r ence or am(ail buying the following described real property for which a Homestead Property Tax Stan arJa Deb./1668n is hereby claimed
unde ntract on the date this application is filed, (date of filing). I(We):
Own ❑ Am (are)buying under recorded contract l�lt� —
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation GIBBON COUNTY AUDITOR
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
n `, e5�.e/•-� 1_.�. 7 :,- -:a -_sCLAIMANT S_INFORMATIONr::- r7 ':' ;t.`_.. _
Name of claimant(I ame)
/'
Social Security number of claimant's spouse(last five digits) Driver's license/Identification/Other number State
of claimant's spouse(last five digits) -
' CONTRACT;RECORDED } .- .. . .iy
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number 1 Page
.I
- - - 2PROPERTY.DESCRIPTION _'i: -
County Township Taxing district(city,town,township)
rcel nu r Legal description - Is the property in question:
6- (7 b$. 'fQD.Ob3(03 4 -02 ' ❑Real property ❑ Annually assessed mobile 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.
- • . PROP J
ERTYLOWNED BY CLrMANT INOTHER-COUNTIES _ ; -
County Township County Township u
ig of claimant _ .-I"
I hereby certify the above statements are true,correct and complete.
••dr- (number and street,city,state,and ZIP code) -
�� -
lb 44 _ v• acv OwQwvl _ 14 _
7/ ASSESSOR USE ONLY _ I TRUE TAX VALUE< ASSESSED
AT 100/°OF TT„E. _HOMES VALUE- I NON-RESIDENTIAL. '
Land not exceeding 1 (one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Dwelling (4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home 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, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
.STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
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-half(12)of the assessed value of the mobile home or manufactured home.
Signature of Auditor - Date signed(month,day,year)