Mobile Home_Adams CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
' 1't STANDARD /SUPPLEMENTAL DEDUCTION FORM
III State Form by the(Dep/12-09)ent
HC10
"�"- Puesaibed try fhe Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. lir
Z1 5qt"_rtT`.,:-h +'t 1 a girtIL_ �d'-`0e ' CERTI-firedION STATEMEN airs .e f it . ;:ti s5: 7 .0 °:L5
1(We) S.` S. ,An 1 certify the . we :I t . • ,• •' r. . ,•
place of residence or a A are)buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
I -etract on the date this application is filed, (date of filing). I(We): FEB 1 2012
Own
' E1 Am(are)buying under recorded contract
C.J.
❑ 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 bus •
❑ Am (are)the shareholder, partner or member of the entity that owns the property. GIBBON COUNTY AUDITOR
g43II.I.Iii -? yi.+1R. 'k-#:. }z..".'.>d'"t3. cis y;^ CLAIMANT S INFORMATIONsZ- s'r5",. .iCkkti.ra' 5.40- li'" i f L:_.x'.'a:14i
Name of mant(legal name)
Social Security number of claimant's spouse(last five digds) Driver's License/Identification/Other number Issuing State
of claimant's spouse(last five digits)
3-.€:i -lit'f q3t -,*,fi _t ? _<^ , /: cif ,r...,.... CONTRACT RECORDEDro +i ay.. r. ;r`..Yr�:S>,11�?3 n�ii k ,t...Ca:�t'".'s ., __k.:r:.
..� .`<'t':l°V.w.,...-...I1:i,T--. �..l.�.sItLJ��N\:-Y:°��i21�.3YW�� _ . .
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
: a _r$ Ssz3,;;; {42!..km Lh4g-i-.47:f ZartP.ROPERTY;DESCRIPTION...SQ &P'fi i NWzc 3stithai:
description Is the property in question:
0 • • .-Gig �_>♦ I t J ♦ L. ❑Real property El Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that I 6 .lately sunaut�r-' .to produce income,describe the use and portion
of the property utilized to produce income.
a,s ^fi s.N42:::^ .s. ... ? 1-,2, t_si.:. ' = PROPERTY OWN Li,li ,C L`ATMA OTHERiCOUNTIES ,q,SI:t >_,_r;.Wl irl.s` ,,,,, },'#
County Township County Township
I hereby certify the above statements are true,correct and complete. Signe e f i 1 1 I I 1 '
Address(number and street city state,and ZIP code) O
17isrr•1+ w . fEyee s s S E r xrrt Vi 11: ry rot.c 7ASSESSEDVAUE,RIiO MESTEA3D a" 4• ONRESIDENTIALt_'f
, ru}yASOR UONLY $i"T i2.� 1 TRUEIT VALUIAT-1 0 Opie OF TTVk a4I•VALUE I- . + -:-VALUE. tIr6;: 's.?:
Land exceeding n fi• csrrounding residential improvements. (1) - ix r s N �
q x +
Other land (2) ''-'
Total land(line 1 plus line 2) (3)
s
Dwelling (4) cat tr
c kdbacr c,..,: ary ResidentialImprovements or Annually
Assessed Mobile/Manufactured Home i 3 $`
Garage (5) I } . y ? •
Other Improvements (6) _ "'..`t ' „rt. kF:
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus fine 7) (8)
hereby certify the above Is true,correct, Signature of Assessor Date signed(month,day,year)
I/� and complete. 1r' r`
\ Verifying action Signature of Auditor \OA\ fl, \� \ Date signed(month,day,year)
- \ y
yes y,�t 4 c.a'i'?.�„..62-en, tti w_crY-" i�isTANDAR6 DEDUCTION'ALLOWANCE=t-` 1.V 2gr;- sr- �:. 4y 4:1,
_._ «.t rer:x�.-1' - ._..-... -_.... s- m..�.,..-.T:rr.k_ .ii? .ef`�et.:sf �.:..-_7 .�ti,.._
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductions fronded in IC 61.1-12 to a mobile home That is $
not assessed as real property or foe manufactured home that is not assessed as real property may not exceed
one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)