Homestead_Cox (3) �o CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
i4_ t STANDARD / SUPPLEMENTAL DEDUCTION OR
State Fan)5473(R13/12-09)
S ,e d' Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. I ) i ',,
I(We) . c . 4 V� certify/that I(we)occupied as my(our)principal
place of re-dente or am(are)buying the following described real property for which a Homestead Property TI x Stan(ifolbeil&tigEllehereby claimed
under contract on the date this application is filed, (date of filing). I(We):
❑ Own ❑ Am(are)buying under recorded contract
❑ 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.
_. .T-.. 54- .:.- -
. _ _ =- ..- !�,._..'`�''' CLAIMANTS'INFORMATION �y��s.-...')�s�?. �','�aa �t�,�^i�i�s:r�'� .....a-;
_ _,.
If buying on contract,Fee Simple owner's name
Recorders office where contract is recorded I Record number Page
?'_ e s ? r: ./.,t-::-:_:' - - 2 _ .PROERY DECRPTION-:... . . . " a T T= -
County Township
Taxing district(city,town,township)
Parcel number Legal de 'ption /n� ,, p(y/.�L_LIs the property in question:
_ - /0 4.zie I ❑Real property Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exce ing one(1)acre that immediately surrounds that structure is used to produce income,desaibe the use and portion
of the property utilized to produce income.
02&_ Iti _h'- 3oy - oo0 . 3 / / -007
_ ;<<, - _. ::. _P TROPERTYvOWNED BY.CLAIMANT IN OTHER COUNTIES �"- -.
County I Township County I Township
I hereby certify the above statements are true,correct and complete. Sign ure of G ' a i
x/
) Address(number and street city,state,and ZIP code)
/ \-4) 31 V15/0& l-
OAKLaD a S-/J 76& o
'•' s . ' r ASSESSED VALUE HOMESTEAD NON-RESIDENTIAL'—
ASSESSOR USE ONLY -I TRUE TAX VALUE I - -
- i3G. ATe100%,OF:TTVi - VALUE: - -.VALUE
Land not exceeding 1(one)acre immediately
surrounding residential improvements. (1)
Other land (2) i
1
Total land(line 1 plus line 2) (3) i
Dwelling (4) •
Residential improvements or Annually
Ascsvd Mobile I Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7) I
Total value (line 3 plus line 7) (8)
hereby certify the above is true,correct, Signature of Assessor I Date signed(month,day,year)
I and complete.
Verifying action-Signature of Auditor I Date signed(month,day,year)
-_. STANDARD till _
- ` - - ._+ - y - STAND_ ARD: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.
signs re of Auditor .�`/ i Date signed(month,day,year)