HomeMy WebLinkAboutHomestead_Amick . CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
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-, STANDARD/ SUPPLEMENTAL DEDUCTION HC70
State Form 5473(R13/12-09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
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'zr _�-`�'tr( ��>+..�' ,-���`�. ��-�-"b �rCERTIF.ICATION STATEMENT.,.= �€'__�: isa" � +�=Cr�9 wa ta+�e
' I(We) ,�!��^ir �L ,m, ` M ,•. _____ certify that I e) •:• "s- 0 I.IciPal
place of - idence or am(are)buying the following described real property for which a Homestead Property Tax Standard Deduction is e -•• "aimed
under contract on the date this application is filed, (date of filing). I(We): JUN 2 0 2014
❑ 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« ,*!'�- /%4AA�
3❑ Am(are)the shareholder,,paartner or member of the entity that owns the property. GIBBON COUNTY AUDITOR
3Y tiril `tom; K 2a-. '$`76it� ` � MiIN_TES`jINF.oPlaie ON aWs agartg tal,Miira t'2a
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If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
'-.4a.2 fs- -title -,4.412$1ir a :. 4'PROPERVDESCRITION "r.ft.r.:3 i 7tih- ?Ciksrk''3:`a • a'
County Township Taxing district(city,town,township)
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Parcel number Legal description SF '- ❑- / I Is the props Real in question:
o� property Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the and 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. Signature of imam
X64.11' /Address(number and street,city,state,and ZIP code)
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.•.: r' +aifigt s%r'' t' r ''.'r A SESSED VALUE l 'HOPAESTEAD 1rt-^'o-NON RESIDENTIALf> '
r gfsASSES O S.,„a rr Legia4 R�,k'TRUE TAX VALUE IMAT5100%I.OFJTsT,ViliaTAIVAL'•l1E>"t t klet..r't�s4.w-5^s-.1•VALUE`ts`+ Y e
Land not exceeding 1(one)acre immediately
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surrounding residential improvements. ti) a ,k. " -
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Other land (2) .t x " '‘f-l-.,1•1-1.
Total land(line 1 plus line 2) (3)
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Residential improvements or Annually Dwelling (4) r -a. *
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Assessed Mobile/Manufactured Home - s
Garage (5) ' '":- ��-
Other Improvements (6) ":::?•-•-;.':.".S;