Homestead_Jarvis flCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION Hcm State Fatal 5413(R17/1-16)
Prescribed by ere Oepmlieru of Excel Gmemmcs France
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone.Soda/1Seccu/ritlyt,driver's license,state identification and federal identification numbers are confidential under IC 6.1.1.12-37.
I(We) I C 1'T Ps-k ` A R✓/j certify that I(we)occupied as my(our)principal
place of residence or am(are)buying 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. (dare of signature). 1(We):
X 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 terms of a qualified personal residence trust.
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
II buying on contract.Fee Simple earner's name
Recorders office Mare McVay:rs recorded Rerun manta Page
MAY I2 4 20181
r.., .. .: PROPERTY DESCRIPTION - .- .- . .
/�,+� Tom. TaxigorsrcAIvry(own.tpew.q)
v � �S0A1 j JUkNUJ L-:.: 1
�r�, IIrr��'7.OY�legal dCscrpten teNepropeey"° GIBBON COUNTY AUDITOR
\I.aa _I<-.ige-VU_'`1l I1iSW SLJy54ff /y•131AC- I�Real prwaly ❑ arnary assessed mobile tome l/e sf.f-n
OIf anyypporton oi the residential structure a Ne/tend not exceeding ale(I)ear that irmede!ety swwnds that mixture is used to prodxe inm ee.describe the tee and port on
at the property uttered to produce income.
aG - aa.- is- 360 - DOD. 4qq- crate
_ t 1. . . ._ z PROPERTY OWNED ELSEWHERE 13Y CLAIMANT r
State,County.and Ta nvup Is claimant vacating a homestead?
❑ Yes ❑ No
ISgra use Mclaimant
I hereby certify the above statements are We.correct,and complete.
VAccess of=dad(muster and steer rty tt te. •LP code) Aa ass dvaraled ad,g any(number and scree;ay;Yat.and LPCOde)
a$d? S. Ow:WSvfeo�I A��ST�ai /N ef76'39
ASSESSOR USE ONLY ASSESSED VALUE _I HOMESTEAD VALUE- 'I NON'RESISIDENTIAL
ILand not exceeding one(I)acre immedlately I(I) I
surrounding residential improvements •
Other land I(2) -
Total land(line 1 plus line 2) I(3)
Residential Improvements or I Dwelling I(4) I •
annually assessed mobile/ -
manufactured home I Garage I(5) I - ,
Other improvements I(6)
Total improvements(line 4 through fine B) I(T)
Total value (line 3 phs line?) I(8) I I
I hereby certify the above is true,correct, i Signature w Assesses I Dare waned(moms.day,year)
and complete.
Naufag aden-la aaae of ACO• .Date aged(r;h.day.year)
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545.000.
Nofwrthstandi g any other provision.the sum of the deductions prodded in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to o manufactured home llal is not assessed as real property may
not exceed (1/2)aea asserrotire home or manufactured home.
Date signed(comet day.year)
>�� Say-/Y
• DISTRIBUTION: Original-Coady Aod:lor.Fie-Stamped Copy'Taxpayer
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