Homestead_Stewart (8) i..,,`t CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION OR
"5` t'a State Form 5473(R13/12-09)
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�' ' Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for firing instructions. '
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I(We) MIRIIk _JI ,I/Ll• certify that dSrrTOdd ied as my(our)principal
place of residence or am(are)buying the following described real property for which a Homestead Property Tax is hereby claimed
under tract on the date this application is filed, (date of filing). I(We):
Own El Am(are)buying under recorded contract —
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation GIBBON COUNTY
❑ 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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�,} `.-` t- p w�'��-+ '''r �''+--� 'g,�CLAIMANT'S INFORMATION g -•
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If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
` s 'a `p•' -�` v 'R;3} � , 4€''tr P,ROPERTY DESCRIPTION m(,' t ii 'j' qi g'F i 3:*;
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Cau V Township Taxing district(city town,ya,4 ,
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Pa number Legal description Is the property in question:
cL/a-07-303-00/. a 181308 ❑Real 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.
t d 4' -:—D a a, PROPERTIYY OWNED BYs-ci_E M atiiiIiTHER COUNTIES_,06141-ig ^.'.r:' ,fxi'•"arat
County Township County Township -
I hereby certify the above statements are true,correct and complete. 5s ,.,re Y ,� i
Address(number and street,city state,and ZIP code) �C
I2 ( •
yadThei r yrt-s'ra �-#trap e;i:tW� ''""*`c• 1 gASSESSED VALUEr3 HOMESTEAD S��ki�'Y6NON RESIDE jiIAP*A;1`
11 W�_ ASSESSO SE,ONLY ^��, Fp n' TRUE TTAXrVAL"L1Etl ATS100%i ..OFxTTTV:S lliiVAllUEi .S��ri- S:TTS''• VALUE h
Land not exceeding 1(one)acre immediately rY .. }
surrounding residential improvements. (1) ^r'.. -:"-,._-C.-
Other land (2)
Total land(line 1 plus line 2) (3)
iflkr'l :lj r 1 Q:.
Residential Improvements or Annually Dwelling (4) -�? rs�n - ; F
Assessed Mobile 1 Manufactured Home Garage (5) -n ,-4 ' r'-:`rr'.
*. -,..,.,l,.•C'u`rt >
Other Improvements (6) ,.. . .. .-..14.r:
.
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
Year)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month.day,
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
,,F za�+4:c^" cYIR xr °' At .:1 STANDAR DEDUCTION ALLOWANCE-`: .��' ''�`'t `n3 egt13 C?r - iv y.
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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-ha1P(12 of the assessed value of he mobile home ormanudactumd home.
N itnr Date signe2th,da year)