Mobile Home_Farmer CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
>— ti STANDARD I SUPPLEMENTAL DEDUCTION FORM
Sate Fors 5473(R151 5-14) HC10
Y.
Prescribed by the Deparonent of Local Goverment Finance M
INSTRUCTIONS:See reverse side for filing instructions. I I III
( NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers are confidential :1:7 IC h I. 112-37. :_,
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Yrl • CERTIFICATION STATEMENT "..t - ) h't "f"U * j
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I(We) ,,'� 1. '•W_ certify:hat I(we)occupied as my(our prince-
place of resid-I ce or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Dedu<3:•on is If reby claimed on the date this application is signed, (date ofPau4). I 4015 Lam/Own. ❑ Am(are)buying under recorded contract.
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. d
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified •S t ',a"E't 7 1 rust.
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. GIBBON COUNTY AUDITOR
.. _ - c-. CLAIMANTS INFORMATION..10 t._ ' ,71..:t-
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Name• .nt(legal name)
Social Seventy number of claimants spouse(last five dg4s) Driver's(vans/Identfabon/Other number sm g State
of claimant's spouse(last Eve eig s)
I
=r- - ..= ;;C=C:-.7 CONTRACT RECORDED__. _°'T . r _ .,.-. -=-t
If buying on contract,Fee Singe°inners name
Recorders office where contract is recorded Record number 1 Page
s _ -.:41_,2,..- ;• 'PROPERTY DESCRIPTIONS i=.'.1*-L- =-; —..._ a° ,.:5:-s.�"r2=' 'i
Gow nTownship Tan g dagi (caw 101474 favnshy
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Pa/mJe/I num (//� A Legal desorption Is the property in ques'vm: �/
�// ?il /)1 /t65- ❑Real property Annually assessed mobile home(IC 6-1.1-7)
`L'/Iannyy patonn of the resideral gustruotteW or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce icon,desmbe the use and portion
® of the property utilized to produce icon_
9014 .: ,a..
Sax,Casey,and Township I Is claimant vara- a homestead?
❑ Yes 7No
Signature mom
I hereby certify the above statements are true,correct,and complete. 44
Aidresa of contact(number end street 01%ante,and ZIP rude) I of vacated ��,ty1(meer end sleet. stn••,,a,, :prre)to
5- /y�o t TT�E�/
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ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEADVALUE I NONRESIDENTIAL
Land not exceeding one(1)acre Immediately I(i)
surrounding residential improvements
Other land 1(2)
Total land(final plus line 2) 1(3)
Residential improvements or Dwelling (4)
Annually Assessed Mobile I •
Manufactured Home Garage (5) h
Other (6)
Total improvements \ \I
(line 4 through line 6] (7)
Total value (line 3 plea line 7) (8) I
I hereby certify the above is true,correct,
Signature o:Assessor Date signed(month,day,year)
and complete. 1
Ve-t sedan Clb
\
Signature of Au
ll 0 Innth• ! ye. ?
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9 T " a=STANDARD DEDUCMONALLOWANCE.' t' ' "-�_
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000 FEB 4 2015
• NoMtthslanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home not S
that is not assessed as real property or to a manufactured home that is t assessed as real properly may
not exceedo e-hat f(12)of the assessed val • the mobile home or manufactured home. •
Sgnabue ofAu' or a I� w Date c... e,y;, tY' 'J
44 �I�_ �� CID Jth jj1AUDIT R
DISTRIBUTION: Ongthal-C yAW:.a,FieSamped Copy-Taxpayer