Homestead_Delong ,An. CLAIM FOR HOMESTEAD PROPERTY TAX - YEAR
r. ";' Fay
STANDARD/SUPPLEMENTAL DEDUCTION -
Saes Fam 54730117/1-16) HOW
at Presorted by the Department of local GvAas=Fano
INSTRUCTIONS:See/averse side brfing instruclmns.
NOTE Telephone,Soda)Security Mimes license,state idengrffion and federal ldenw aSon numbers am confdenfiai raider IC 6-1.1-12-37.
I(t) • certify that I(we)occupied as my(ow)principal
place of residence or am(are)buying the foaming described real property under for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date Of slgnatuu{g). I(We): - �p��,
❑ Awn. ❑ Am(are) child under recorded 71
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative ho 'rig corporation. l/
O Have a beneficial interest in the tout or the right to occupy the property Lind terms of a qualified personal residence trust
..❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
- -
Canty bonsai, Task tam a(oh:kern Wens/0 ..
.
Pawl outer lagd dmoiprm 1 Is b poverty n q
e
❑Real pcpMy ❑Assay assessed=tee In(IC 6-1.1-7)
tl any paten a the residential Prunus or the land not mesas;an(I)ape that kmeaa*N sarprd5 that savage is used to poduce home,desaEa the rose and Paton
of are povety utroed to prod=incase
6 )8aS 100 - goo . I i s- ads
...3s�:`Z•'a" _u I _' F".r '',PROPERTY.OWNED.ELSEWHERE 6Y CL'AIhfA'NT„T Cr o - - -?+ .'ten..ics+__
gam,County,and Township Is claimant vacating e tmtnestead?
❑ Yes ❑ No
reitae
I hereby certify the above statements are trim,correct and complete.
Address of mmmo(natraa Sleet city,Cate,and ZIP add Adders d mated tssnestese deny punter aids • .and Wade)
A. 47 7w Bros 6leA w C
•
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//
U ASSESSOR USE ONLY yam.,_ 1- • ASSESSED VALUE - yy I HOMESTEAD VALUE -,I .E NON_RESIDENTIAL 74
VALUE
Land not exceeding one(I)acre Immediately xs $- " -_
surrounding residential improvements 0) :lax. -Ic U -
Odor mod (2)
Real land ine1;Pus line (3)
Residential menI or Dwelling (4) FIT J :... B
2
° r v xs --:
annually assessed mobile/
manufactured home Garage i s
Other improvements (6) Yc _'JAIY 2 6:.20:1
Total Improvements(line 4 through line 6) CO
Total value(line 3 Plus line 7) (8) I I/ _
I hereby certify the above b true,correct,
'�°e of Assessor GIBBON COUNTY A I Dfl oR (moat�Van
and complete.
i4Nyic taco-Signature of Mate Dam semi(iota dal:lead
20 pay 20 Lesser of 60%of the assessed vane of the homestead or$45,000.
NMsitslandrg any ofherpm'Sion,the sum of the dedldions provided in IC 6-1.1-12 to a=Me home $
that Is not as real property or to a menuFxti ed home Mans not assessed as real pope*may
not exceed (fIV of Me assessed vaL - ?LJ bia home ornwtWachned home.
Weer,old I Dale signed(matt Ma)ewd`
o‘-1 el
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