Homestead_Jones (7) <" . CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4_:::" ; STANDARD/ SUPPLEMENTAL DEDUCTION FORM
- HC10
r•-- '---�. State Form 5473(R13/12-09)
"- -.' Prescribed by the Department of Local Government Finance r I
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INSTRUCTIONS:See reverse side for filing instructions. - 1 / —`i
���CERTIFICATION STATEMENT _ UU
I(We)�\u�r. lb' �' . i s ° liSa. >tt• certify that I(we)occupied as my(our)principal
place of r idence or a (are)buyini the following described �l property for which a Homestead Property Tax Standard Deductio . by claimed
under contract on the date this application is filed, (date of filing). I(We): i, f,
n ❑ Am(are)buying under recorded contract GIBBON COUNTY AUDITOR
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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.
r, _. _qr„ ,;ik+4.l/•- . „7-. _ :LCLAIMANTS,INFORMATION;,_ , i s.c ' °' • 1170_`
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If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page '
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- - PROPERTY DESCRIPTION -
County Township Taxing district(city,town,township)
Parcel number Legal description Is the property in question:
❑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.
02 zo-/ 9-is- x616 a-7/ 367 - da
_ - PROPERT,I'/OWNED BY CLAIMANT-IN OTHER COUNTIES-- _ -.. , ...--:.-
County Township County Township
Satur claimant - `
I hereby certify the above statements are true,correct and complete. • n
•.dress(number and street,City,state,and ZIP code) , / I'•,r-"`,',I,�
V ASSESSOR USE ONLY. -O Y_ L -N,-TAX VALUE- -AT 100/OF ITV. I HOMESTEAD I NONLRESIDENTIAL
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Land not exceeding 1(one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Dwelling (4) '
Residential improvements or Annually
Assessed Mobile I Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 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.
Verifying action-Signature of Auditor Date signed(month,day,year)
' - STANDARD-DEDUCTION ALLOWANCE - -
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-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)