Homestead_Devoy a YEAR
CLAIM FOR HOMESTEAD PROPERTY TAX FORM
; _ - = STANDARD/SUPPLEMENTAL DEDUCTION' HC70
State Form 5473(R15/5-14)
I Presaibed by the Department of Local Government Finance '
INSTRUCTIONS:See reverse side for filing instuctions.
NOTE:Telephone,Social Security,drivers license,stale identification and federal identification numbers are confi n'al er 6-1.1 2-
I(We) �k/v certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the followin cubed real property under contract for which a He • t a Pwwprir� x Standard
Deduction is hereby claimed on the date this appli n is signed, (:{I-: s4rihw6J1 IWe):
❑ 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 termxttLa_gp ence trust.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. 6 SON C LINTY AUDITOR
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If buying on contrast Fee Simple owners name
Recorder's oboe when contract is recorded 1 Record number Page
i'...t tL+e;ts�L -�-a=_t - a'- . 3i PROPERTY.DESCRIPTION£ g _ r-y:<a- .a.E_._ i :;.'.;a.r„3si
County Township I Taxing distid ,lam,township)
P^I A�
Parcel number Legal desopen I Is the pro . in auesxn
, 0-0 �a 3-co3.VSO—0 u
x Real property ❑Annually assessed mobile home(IC 6-1.1-7)
If any polon of the residential=nuns or the land not exceedig one(1)eau that mmedia:ey surrounds that srudure is used to produce income.describe the use and portion
of the property uti¢ed to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sato,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
Signature of claimant
I hereby certify the above statements are true,correct,and complete.
Address of ad(number and weer.Cdy,state.a..ZIP.... I Address of vacated homestead,a any(number and street ray.sate,and ZIP code)
./ -ise, i! . I Li - _ 1 il < is a - - •- -I-4 n q Mkt 4 0
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NONR/ESISIDENTIAL
UE
Land not exceeding one(1)acre immediately I(1) I
surrounding residential improvements
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Other land I(2)
Total land(line I plus line 2) (3)
Residential improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line d through line 6) (7) p
Total value (line 3 pits line 7) (8) gBR
I hereby certify the above is true,correct, Signature of Assessor Data signed(r:nah,day,,year)
and complete.
Veifyi g action-Signature of Auntor SAV g ni 44n4 VJ5y
a,
20 pay20 Lesser of 60%of the assessed vaueof the homestead or545.00t1 GIBBON COUNTY AUDITOR
NoMithstending any other provision.the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed e-half(1!1)of the assessed value of the mobile home or manufactured home.
Sgre:we of W V W `-/ i 'i Drs 5-(nosh.day,year)
D15TRIBUI'1ON:Original-County AUdior,Fie-Stamped Copy-Taxpayer
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