Homestead_Deusch ,, CLAIM FOR HOMESTEAD PROPERTY TAX ORM YEAR
v ii F
STANDARD/ SUPPLEMENTAL DEDUCTION O to
y..-,;' State Fonn 5473(R13112.09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
`-n��nvr r. �g,�.,�`[,;r� r--.,pT - ' " n C'ERTIF.IFATION7,TF•;TEMEhT �� -� t 'r'3atlRtz�-£mT"3is "r' 'r*.'L'Ik'.� . 5'
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I(We) A,-il �gniale . tPM-���I/.LWla certify I ( e).".•. pt s t)r)principal
place of residence or am(a 6 buying the folio 'ng described real property for which a Homestead Property Tax Stan.a . •ed r .. 1� by claimed
under contract on the date this application is filed, (date of filing). I(We): 9 El Own ID Am(are)buying under recorded contract JUN 9 2014
Q An (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
1:1 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified pers
El Am(are)the shareholder, partner or member of the entity that owns the property.
GIBBON COUNTY AUDITO'
roil nalThi ivr- ialitg ..r�.•�LYDii_�. -- CI IMA_NT a70RMATION Mr'�e°SS-ran 4 * u:.x-1Y ='
•'�H �� �«lL '�.Yti�S-h��II
i!'§,t .aa�r �
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
'.`sArreg. ?- a .+x..z' c,.: s_+'"-�- �°ialltF TTYab.ig RIP�T ION +as .rgiritS-,.•��v 7• -". -.._.34TTi3t�' _WY3r
.. `a Township Taxing district(dry,tore ship) .
a//mm1���JJ number Legal description Is t e•nearly in question:
N0-, -&I-1 co-co n!► ..{06 rip-.1 property CI Annually assessed e (IC 61-1-7)
If any the property of utilized to produce Inoomhe re or the land not exceeding one(1)acre that immediately surroun• that structure is used to produce income,describe the use and portion
of "' a naa-nal y.'�"`a• PROPERTY OWNED16Y_(CLAIMANT'IN OD-1Efi OU NTIEiAZI ti,,'-ife.rij ia?s„ l F',� AA',`L:
County Township County Township
I hereby certify the above statements are true,correct and complete. ` daimam /
�25iress(number end street,city,state,and ZIP coda) �j ,/� D ���
*0 ' r Z) .�. /!//� �� T
+fir.='" - -r 84' s.S±+iyf`-r4C1v"-�f 5';k: g`''^'F ASSESSEDTVALUE.r..HOMESTEAD 1 tt NONRESIDENTIALi li
- i�"k EIS s itON Y`,..a. 'IC TRL iii EkVALKE tI'�ATd100%OFaT,T,Va1:(rv.��"+IriVAL•UEc`"`Or t', . �.rsS,_+ :VALUE 5 1.. -v #�-
Land not exceeding 1(one)acre Immediately (1) '. .?E ' ,. S` :0--,.t.
surrounding residential Improvements. -- --Other land (2)
Total land(line 1 plus line 2) (3)
r _. "�
Dwelling (4) l < ;"0 n - {-
Residential Improvements or Annually Assessed Mob e I Manufactured Home -.;- S-, '
Garage (5) -.12';1i;.., ..-1.-.}_?- , : �-.
fa-S'Y
Other Improvements (5) _
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)
alert aat>> f'n STWDARD DEDUtilli ill1 WANCE s. . rx'x ` '�(r,� �i -,y tole a3y�n
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 properly or to a manufactured home that is not assessed as real properly may not exceed
one-hell(12) -assessed value of 1h- hdme or nufacruid home.
Signature of- •i or) /U Date signed(5fh day,