Homestead_Montgomery (2) 'f: ' r.
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
��-� STANDARD/ SUPPLEMENTAL DEDUCTION
,�:a4;' State Form 5473(R13/12-09) HC10 /y /!�
``" Prescribed by the Department of Local Government Finance �
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`4'ti�.y'�'•F•� �`�_ /���;��.:�e�-.��r�ERTIF,ICAION STATEMENT - �"a-_,3nm k�.��':tz�'".�3_a.nt.��:''-ft•---.v.r
I Nye) .1-I_%//1L%�L�l� edea certify that I(we)occupied as my(our)principal
place of residence or a tee)buying the following described re!fproperty j" ich a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing). I(We): ��
❑ Own El Am(are)buying under recorded contract
p 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 residj'�e"rust 2014
❑ Am (are)the shareholder, partner or member of the entity that owns the property. ,,3, AY'( i 4 4�y
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Name of claimant(legal - 'e I!f/Pr i
So / GIBBON COUNTY AI ID•
Name of claimant's spouse(legal name)
Social Security number of claimants spouse(last five digits) Drivers license/Identification I Other number Issuing State
of claimants spouse(last live digits)
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��'4*.ice ".:r'�,'s..r3.'�iL; '?gs+� _va ONTRACTILREC-ORDEDPa r exam..m. ,aYsa .,2,:t ikri a .s,�.ra, ._ci
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
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°x' t t� �' PRO_P,ERT,Y�DESGFi1PTION,�i„�y� fh�,. iY.t�'Y-�sN�:i;;E:^t..3'�:L.-s. �>�`t-.a=•,.••�
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1 -w a i- d G o y a - °c)
p.}�.,�ywg ,ipatr :�`�}�'� PROPERT,YjOWNED16�CLAfk)A[sT,INGOT,HEf?+COUNTIESa�.t'�"�u'x�'#+.'�'yn3}E.Sit„n`.;+"hi �"
County
Township County Top
I hereby certify the above statements are true,correct and complete. Signe dm t `
Address(number end street,city,state,and ZIP code) n 1 7
.a a.,•tai trgiatj &.;t4.:e <s? /t''-'S`5 !(`?" - `" '' ;/ASSESSEDtVALUE Ies`JHOMESTEAD-y.� ON RESIDENTIAL!:-. ty4'
�Z �` 3v ASSE�S,SOR USE ONLY; ¢ - hTRUEi_T� UE I "s-r
'.:,s'fi. I' -,il�'AT5100%IOF:tT�TV.3,;'I- `SaiVAL`•UE.Jr t_ �.'es,VAL'UE ;d." 7-_
H 4:
Land not exceeding 1(one)acre atety (1) r t• ` >
surrounding residential Improvements.ents.
Other land (2) _ - a
Total land(line 1 plus line 2) (3)
Dwelling (4) �.. -141 7 ,:,. v ./ .-f
Residential Improvements orAnnually ., _ ; ;,
Assessed Mobile/Manufactured Horne Garage (5) C ., .... '2.,:...-t--.--,r 7,4w
Other Improvements (6)
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 Assesses Data signed(month,bet `)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
f!= Maria' 3� i ` t t*II`><;571 ANDARDIDE DUCTION ALLOWANC irlS r yam. ' r��- r W.. , y Z-51„tee'
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20/y pay 20 / Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductbns provided In IC 6-1.1-12 toe 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-hall(12)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)
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