Homestead_Goldman (2) CLAIM FOR HOMESTEAD PROPERTY TAX i YEAR
4.1_,.- t STANDARD/ SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R13/12-09) t C-0 1 ill
*' in '! Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
`r. .CERTIFICATION STATEMENT _ - , - _ - _ _
I(We) _4,0 �n///���!'I1�,,r/ certify that I(w ccupie as m (our nndpal
place of residence or am(are)buying the following described real property for which a Homestead Property Tax Stan ereby claimed
,�����unnnn,d{{{der contract on the date this application is filed, (date of filing). I(We): GIBBON COUNTY AUDITOR
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
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
'.
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
Corm. / •' Township I Taxi a district(c1 town,township)
o/� K
Parcel number Leg ptio Is e pr perty in question:
, �� di 1-1/ tyI'h,�,'+RReal 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. �i
do- ova's- doa-ao c�TG -oi? �
. _ _ _ - v PROPERTY OVWNE_D_BY CLAIMANT IN OTHER.COUNTIES .c. '., -'^2-C."«_,, ;K.
C_7 Township County I Township
I hereby certify the above statements are true,correct and complete. Signature imam r (best I01/ (�l61
Address(number and street,city,state,and ZIP code) Lwj�l�/V/-
. A / e A
E - / /7E g lO 2-A, -17'c
ASSESSOR USONY -va I TRUTAXVALUE IASSESSEDVALUE H tilts
EAD I NON=RESIDENTI
r : - --e . E ,AT,100/1OF1TV ,,:is4ALUE s -.t r _ "VALUE-L . ,
Land not exceeding 1(one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Annually Dwelling (4)
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)
y_. - :: � � -'7STANDARD'DEDUCTIONALLOWANCE _- - :_ _
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)