Homestead_Baumgart (2) " CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
•-•_ = STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R1515-14) I-1010•
' Prescribed by the Department of Local Government Finance
• INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,diets license,state identification and federal identification numbers am confidential•i - I -1.( 2-37. i (a
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��\:�� ItL - - --rte'=j:'CERTIFICATION STATEMENT-�/e- �+-/• _
I(We) ItI Y fSS n ���141 — 'r.. • -• - ou principal
Y( P Pa
place of residen - or am(are)buying the following described real pr.:-rty under contract for which-(omestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of iteR/r fl. I(V2015
❑ 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 •-r•,g.. -ii�`/Mie st.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. GIBBON COUNTY AUDIT?R
It buying on contact,Fee Simple owner's name
Recorders oSe where contract is recorded Record number 1 Page
'? 7 �> K*.e +_ a'.i._=-Y 3 PROPERTYrDESCRIM1ONi_.ri
Taavg tlisaitl -.•.• lam- )_r 3 ---rte c rr `irzi
Cowry Township
nP roe'number ber Legal desaiCtion Is the pro ny in question 1
,sr'(� LYReaI IxoperY ❑Arrnuary assessed mobile home(IC 6-1.1-7)•It any portion of the residential sniCure or the land 7not eO' ng ong e((1)acre Nat immediately surrounds that structure is used to produce income.desmbe the use and portion
of the Property utilized to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
-
❑ Yes ❑ No
Signature of Ida' I
I hereby certify the above statements are true,correct,and complete.
([/ t
Address of contact(number and street,say,state,and Z/P code) y�Adddrress of vacated Sad,d any(number • oy,sate,and ZIP code)
/Iv i0 • • • S V_ • I( 1
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-1EA LA
SIIDENL
Land not exceeding one(1)acre immediately ((t)
surrounding residential improvements -
Other land 1(2)
Total land(line 1 plus line 2) I(3)
Residential improvements or Dwelling (4)
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)
Signature of Assessor I Date signed
I hereby certify the above is true,correct,
and certify
Verifying anon-Signature of Auditor I gne t qeJ�rNYDDI--/�/
TIsJj
Y,
',t•1= . _•2 Y _t.;�. -- STANDARD DEDUCTION ALLOWANCE'f - A... =y- - 4 7 gIaT F
1 . I 1
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-14-12 to a mobile home $
that is no assessed as real property or to a manufactured home that is not assessed as real properly may ' M el
notes r.• • e-half(12jof the a-.essed value of the mobile home or manufactured home. `I.e4IWIPr
:a di wee (aaEn . oR
_ •/ I . 5
DISTRIBUTION:(Signal-County AUd.tor,FieSamped Copy-Taxpayer