Homestead_Barron CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4".."'1/4) STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Fenn 5473(R15/5-14) HC10
Prescribed by the Department of Local Government Finance i
INSTRUCTIONS:See reverse side for filing instructions , i
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
017
01/
41 Krt s ✓ certify that I(we)occupied as my(our pnna
place of residence or am(are)buyi g the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I yi -): •
•� t• 110n11i
heOwn. ❑ Am(are)buying under recorded contract GIBBON COUNT AUDITOR
❑ 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 residence trust .
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
__.
If buying on contact.Fee Sin pie owner's name
Recorder's o3ce where contract is recorded Record number Page
sl -di "`- i2J-72XY15 :' PROPERTV,DESCRIPTION` r igra7s-=t�+�'s'J�
Daoy
Township rang district(ury,'mn,
Parcel nr_^rber Legal desairdon Is the property gg .
in vuesto
L_ t43— V ^
v 1 _s�DO s ��.J 5 -D O M Real property ❑Annually assessed mate bone(IC 51.1-7)
If any portion of the residemial structure cc the land not exceeding one(1)acre that immediately surrounds that structure is used to produce'umme,desaibe the use and portion
of the property seined to produce income.
-. PROPERTY OWNED ELSEWHERE BV CLAIMAM- ' _ __ .. '?'�:-_
Sate.County.and Township Is claimant vacating a homestead?
' ❑ Yes No
SiPraW. tnant s - - _
I hereby certify the above statements are true,correct,and complete. if/
w
Address 5 contact(numb*.asd tea^^ :•,end P code)/ Addre s of vs--' and sreet-. states,end`—ZIP'code)
ASSESSOR USE ONLY . ASSESSED VALUE 'HOMESTEAD VALUe1; NON-RESIDENTIAL if
ASIrs.c.if,d1) 4•0
•
I �. tl VALUE'
Land not exceeding one(1)acre immediately r
surrounding residential improvements I(1) i'�,•` _
Other land (2)
Total land(line I plus line 2) (3)
Residential Improvements or Dwelling I(4) - r t_ £.
Annually Assessed Mobile l
Manufactured Home Garage I(5)
Other Improvements 1(6)
Total improvements(line 4 through line 6) 1(7)
Total value (line 3 plus line 7) 1(8)
I hereby certify the above is true,correct, I Signature of Assessor Date signed(month,day,year)
and complete.
Ve'iy4g action-Signature of ksd.tor Date signed(iwhi day year)
z -1`._�..�R�3g> =.. STANDARD DEDUCTION'ALLOIN
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Nohsith5anding any other provision,the sum of the deductions provided in IC 61.1-12 to a mobile home $
that is not assessed as real properly or to a manufactured home that is not assessed as real property may
not exceed one-half(12)of the assessed value of the mobile home or manufactured home.
Signal- of PUd or Date signed(month,day yeas)
Lk.- a`{'-,11
DISTRIBUTION: Original-CountyA:N_don,FieStanped Copy-Taxpayer ,v