Homestead_Richardville (2) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
,a R STANDARD / SUPPLEMENTAL DEDUCTION FORM State Form 5473(R13/12-09)
�O ,� Prescribed by the Department of Local Government Finance
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INSTRUCTIONS:See reverse side for filing instructions. ',�
_ -- ��/�- CERTIFICATION STATEMENT .
I(We) ♦ -/—I I Y I I_���f i l l I Ce�y g,_II1 ... . .. as AM as my(our)principal
place of residence or am(are)buying the following described real property for which a Homestead Property Tax Standard Deduction is reby claimed
under contract on the date this application is filed, - (date of filing). I(We):
❑ Am(are)buying under recorded contract GIBBON COUNTY AUDITOR
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
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
w: 92i4;. n-7-- - :CLAIMANT,SiNFORMATION... _. - s=_" .m-.,4.-,5_.-r5
Name of•i✓ (leg name)
Social Security number of claimants spouse(last five digits)I Drivers license/Identification/Other number Issuing State
of claimant's spouse(last five digits)
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- - _ - - .CONTRACTARECORDEDt- . - - -
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
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PROPERTY DESCRIPTION _ _ -_
County Township Taxing .(7i t 'r•
number Legal description 1 Is h perty in question:
• 2CC al
property ❑ Annually assessed mobile home(IC 61.1-7)
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.
-• -_ •:PROPERT,Y,OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township •
I hereby certify the above statements are true,correct and complete. Signattuurrree ,Ydaimapt � /J^-'�/ll r . ,
dress(number and street,city,state,and ZIP code) '%JiL_
SOS E S .,.ac- r For BwakXI . -II-Cog-lb
ASSESSOR USE ONLY _ I TRUE TAX VALUE°I AAT400%OF-TTVE-- C HOVALUEAD NON VALUE
Land not exceeding 1 (one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Dwelling (4) -
ResidentialimprovementsorAnnually
Assessed Mobile/Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
I 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
Notwithstanckng any other provision,the sum of the deductions provided in IC 6-I.1-12 to a mobile home that is $
not assess d as real property or to a manufactured home that is not assessed as real property may not exceed
one-half(1 ) f the assessed value d��/h ems/ymobbileh(jgr/nJq or manufactured home.
Signature o it �GS' / ' ` "'/' _ / Date signed( th. ay.year)
,t—, "Tr v in