Homestead_Delaney CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
' •_ STANDARD/SUPPLEMENTAL DEDUCTION FORM
' `r State Forth 5473(R13/12-09) HC10
'y:" Prescribed by the Department of Local Govemment Finance (�•INSTRUCTIONS:See reverse side for filing instructions At, p , . 'LED
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I(We) «7aral nflrar't • certify that I( yaq principal e " � 1
place of residen.- or am(are)b ng the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of Wing). I(We):
v)„ ❑ Am(are)buying under recorded contract
GIBBON COUNTY AUDITOR
v 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.
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If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
,.��aa�"x'icy` G 4 �` 'J' ' ` ! y�.r acsY-°PROPERTtY DESCRIPTION y?ii "rWil...3.4itia•3Tr•Li tig_'-,- •_ + R.tf'LA::44'
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County Township Taidry district(city,town,township)
Parcel number Legal/descripponh -1 p Is Ore property in question:
En - 1 n1-b"l-t-1 bl,- n., I , Ij..`(1 -C O Neal progeny ❑ Annually assessed mobile home(lC 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.
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County Township County Township
I hereby certify the above statements are true,correct and complete. Sign re of claimant
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Address(number and street,city,state,and ZIP code
” AP _ ; �„ a - -7 � 6 .6
trateA S SSOR�U E ONLY r ' r,v Rl1E1TyNailEj 4A-I 10047.0F.TV "'v":AVAL•UEt.<TDS�rI-Via:N RESIDE Cd 4
Land not exceeding 1(one)acre Immediately _ cc ,-:-' r ,'
surrounding residential Improvements. (1) ._ r _✓-
,
Other land (2)
Total land(line 1 plus line 2) (3) if
Residential Improvements or Annualty Dwelling (4) Ai2 h'£v ` , . 1:a w-s 4:4- E-
Assessed Mobile/Manufactured Home " .5, r 3 1 `S
(5) . _....' "_ _� i , s..:.:.,
?34`
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)
.1W+ tair i�CIM�i.iia .j. q.'ry' `a701DA.DEDUCTIONALLOWANC Agic r +t w ` § xiiil"nz "s }.
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 to IC 6-1.1-f2 to a mobile home that is $
not assessed as real property or boa manufactured home that is not assessed as real property may not exceed
one-hall(12)of the assessed value of the mobile home or manufactured home.
(z Date signed(month,day:year)
Signature of Putli) ,f _ l�al_