Homestead_Kifer am>, CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
.b A STANDARD/ SUPPLEMENTAL DEDUCTION OR
State Fonn 5473(R13/12-09)
� !• Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
(\ t, 1\ !, CERTIFICATION STATEMENT - -'
I(We) T W T W c. A..L certify 1 1( e) .. piece .11Fur)principal
place of residence or am(are)buying a following described real property for which a Homestead Property T.' Star(dar. Deduction is hereby claimed
under contract on the date this application is filed, (date of filing). I(We): OCT 2 s 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 persona!rat
❑ Am (are) the shareholder, partner or member of the entity that owns the property. GIBBON COUNTY AUDITOR
. -
; .
If If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page•
- _ ';PROPERTY DESCRIPTION - :::::.;j::::-.:„. . •
County Township Taxing district(city;t.,�•wn rp)
ar•- n mber /� Legal description Is ee property in question:
.'-/ W, -O 1 _ I AI 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 surroun 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
g . .
nature . . .. no .
I hereby certify the above statements are true,correct and complete. /
Address(number and street,city,state,and ZIP code)
a 4 2.9 V L-) . J (d_ Sit . co - 'f, .-..c C-10%-.., //`l L17(0 7 0
ASSESSOR USE ONLY rTRUE TAXYVALUE o ASSESSED VALUE I HOMESTEAD _,I . NON-RESIDENTIAL
:-.._. - AT900%AF-TTY .VALUE VALUE
Land not exceeding I (one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Annually Dwelling (4)
Assessed Mobile I Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 0 through line 6) (7)
Total value (line 3 plus line 7) (8)
hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
I and complete.
Veifying action-Signature of Auditor Date signed(month,day,year)
•
. / - $TANDARD.DEDUCTI'ON ALLOWANCE _ _ „ . ._
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000 -
Notwithstanding any other pm vision,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 manufactured home that is not assessed as real property may not exceed
one-h (1 )of the assessed valu 1 the mobile home or manufactured home.
Signatu of ditor It Date spnd(Writ