Homestead_Englert .4 CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
isa.,_. ?; STANDARD /SUPPLEMENTAL DEDUCTION HC10
State Form 5473(R13/12-09)
,�! Prescribed by the Department of Local Government Finance —
INSTRUCTIONS:See reverse side for filing instructions. !
'•
01-1, C tl) 19._ _ •CERTFICATON STATMENT - ,
I(We) • Mill'/1Iil_III - WRT
certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the follow' described real property for which a Homestead Property Tax StandEiBe&141o2al4ereby claimed
under contract on the date this application is filed, (date of filing). I(We):
❑ Own ❑ Am(are)buying under recorded contract a,!vt'
❑ 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.
-'
. If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number 1 Page
l
, �
n r _, . - •• .PROPERTY-DESCRIPTION "7 _ - ' - -
County \I Township Taxing district(city.tow n, ownship)
IA i4 • a e.,,/
Par number d scription Is t/1e tproperty in question:
6—a3.436-3:0-coo _ IyiReal Property 111 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 surrou s that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES; - _ - , - .. _
County Township County Township u
I hereby certify the above statements are true,correct and complete. Sift."da:ma / `
dress(number and street, and •code)
5as' 0 2- cc _bs-I�ci-f- /t/ 7G 3
ASSESSOR USE ONLY. • .I TRUE TAXVALUEd ATfoo%OF.T,TVEI H�VALUE- I - NON-VALUENTIAL•
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,}rear)
- 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:s real property or to a manufactured home that is not assessed as real property may not exceed
one-half(1/2(.1 th:assessed value of mobile home or anufactured home.
Signature of--'•itor Date signed(month,day,year)
•4 ' & 11