Homestead_Bottoms (8)I
3 •.' CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD /SUPPLEMENTAL DEDUCTION
1 • State Form 5473 (R12 /6-09)
N � Prescribed by the Department of Loral Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
H 10
APR 6 ZULU
®If any portion of the residential strucWre or the land not exceeding erne (1) acre that immediately surrounds that structure is used to produce hoome, describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES,
County Township County Township
I hereby certify the above statements are true, correct and complete. "ature
Address numoerapd street, - state, arM Z/PO�Od�e)p [�
ASSESSEDVALUE1. HOMESTEAD NON-RESIDENTIA
ASSESSOR USE ONLY TRUE.TAX VALUE AT 100% OF TTV I VALUE VALUE
Land not exceeding 1 (one) acre immediately 1 rr•�a - Y-- anx,.w
surrounding residential im rovementa.
Other land (2)r'°.
Total land (line 1 plus line 2) (3)
Dwellin 4 °z3fs• ti w `j�•� . Fa&ri7
Residential improvements or Annually 9 O
Assessed Mobile I Manufactured Home
Garage a
Other improvements (6) s 9 y
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)
STANDARD DEDUCTION
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or 545,000
Notmthslanding any other provision, the sum of the deductions provided in IC 6-1.1 -12 to a mobile frame that is $
net assessed as real property or to a manufactured home that is not assessed as reel property may not exceed
one- 2) of the assessed glue of ;he rnobde home or manufactured home.
o itor Date
w e [ryonth, dad year_
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CERTIFICATION STATEMENT
I (we) c
certify that I (w ur) principal
place of resi a or a (are) buying the following described real property for which a Homestead Property Tax Standard De ptiyp is LG�y maimed
under contract on the date this application is filed, (date o /filin G
GIBBON COUN I T A UIIOR
❑ I (We) 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 residence trust
INFORMATION -
Name of claimant legal a
O
Social Security number of
Social Security number of claimant's spouse (last five digits) Driverslicense / Identification I Other number I
Issuing State
of claimant's spouse (last five digits)
CONTRACT RECORDED
If buying on con CL Fee Simple owners name
Recorders office where contract is recorded R
Record number Page
PROPERTY
Coun T
Township T
Taring district (' t
township)
�J
number ^
Legal description I
Is epm ny in Question:
^� L
O / p
property ❑ Annually assessed mobile home (IC 6-1.1 -7)
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