Homestead_Howard (2) CLAIM FOR HOMESTEAD PROPERTY TAX I YEAR
4_^._T STANDARD/SUPPLEMENTAL DEDUCTION FORM
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State Form 5:73(R1575-14) HC10
'' Prescribed by the Department of local Government Farce
INSTRUCTIONS:See reverse side for filing insln,ctions.
NOTE:Telephone,Social Seventy,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
c •. _�•--. CERTIFICATION STATEMENT:e ---I t '- Z 1 f )f'" '1
I(We) h i ri�ingrage Ii _ #i • ,•/ certify that I(we)occupied a m (o f r) .nor .I
place of residence or am(are)buying the following"scribed real property under contract for which a Homestead Property ax -n•ar•
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We): 1 La q C
1� 6
Own. ❑ Am(are)buying under recorded contract. APR 1 . 2015
❑ 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 resi trust. ,
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
AUDITOR
Recorders o3s where wn:rae is visaed Record number Page
?Z-•=.xl OP:C4-''' - 7 + : t ;' .==PROPERT/:DESCRIPTION.-'t-rte `':..-S. . e�i_ASS E
County
Township 1 Taxing di (dry,AA rat
Parcel number Legal description Is the property th question:
al proper./ ❑Annually assessed noble home(IC 61.1-7)
If any poeten of the resider al structure or the lad not esaxdag ale(1)we that vnrnediately surrounds that=inure is used to produce income,desmbe the use ape pox
of the property culized to produce income,
2449 _1/430 _ 4100 00 /. /0 Z7-006
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sax.Carry,and Townsrio Is claimant vacating a homestead?
❑ Yes ❑ No
Sgta:ur datmarc
I hereby certify the above statements are true,correct,and complete. p \lI`II�vyp(s�'�\'�\II ��(I
Address of contact(number and greet,city,,state,and ZIP code) t W Wl/Address of vacated Adm�ea'J d any(number and greet t coy.gam,and ZIP robe)
o >r325(. S. ►200 E OQKlan�d(`,h, IN JJ
0
Land not exceeding one(1)acre immediately (1)
surrounding residential improvement
Other land (2)
Total land(line 1 plus line 2) I(3)
Residential improvements or Dwelling I(4)
Annually Assessed Mobile/
Manufactured Home Garage I(5) I
Other improvements (6)
Total improvements(lined through line 6) (7)
Total value (line 3 plea line 7) (8) _
I hereby certify the above is true,correct, Sgnaarre of Assessor Dares 1 nee m:
and complete. ill
ve-.'yivg action-Signature of AUd:or Dare •(to_:... ....,rear)
20 _pay 2 Lesser of 60%of the assessed vaue of the homestead or 545,000
Abhathstanding any other provision,the sum of the deductions provided in IC 61.1-12 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-hatf(12)of the assessed value of the mobile home or manufactured home. GIBBON COUNTY OR
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6g Date sig
X/_/ , —LS
DISTRIBUTION: Onginal-County Audtor,File-Stamped Copy-Taxpayer