HomeMy WebLinkAboutHomestead_BilderCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION
State Form 5473 IRS 110-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
I , -:*. , CERTIFICATION STATEMENT III --. r H j N i a y
I (We)-,\ AgA--�;4 LJ y III'
,o& cqj0j1h,&4 tf?JUZday of March, 20
1 (We) d as our prikikiplace of residence the following described real property which H it dP perly Tax Credit is hereby claimed:
❑ (We) e w i a es it to
(We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and
y rKS8uyM6uPdera contract.
or uUlt(j,f I
If buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
-"-',0kOPmTYbWNE6BY CLAIMANT IN OTHER-COUNTIES
7PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township)
I hereby certify the above statements are true, correct and complete.
Si re of
a" 7
Parcel number
I I dWriTn
Is the property i . n q lion:
;i -UE-.
)7 k) J, q
I = property ❑ Mobile Home (r.C. 61.1 -7)
If any portion of the residential structure or the land not exceed one (1) aue that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
�,. z / .a,
X — / �20,3 — /,o — ") & - — j d /
-"-',0kOPmTYbWNE6BY CLAIMANT IN OTHER-COUNTIES
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Si re of
-'dress (number and street, city, state, ZIP code)
—.;O� ASSESSOR USE ONLY
TRUE-TAX�-,--;
ASSESSED VALUE
-�,-'-,-NON-RESIDENTIAL
K
VAI
AT 100% OF.TTV
VALUE
'VALUIE"
4,
;i -UE-.
Land not exceeding 1 (one) acre immediately
surrounding residential improvements-
Other land
(2)
......
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
—f
(5)
Other improvements
Total improvements (fine 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct. and
Signature of Assessor
Date signed
complete.
Verifying action- Signature of Auditor
fler h I
20 _ Pay 20_
Lesser of 112 Homestead
Valuation or 56.000
GIBBON COUNT Y AUDITOR I
gnaturp of Auditor I 7� Date signed