Mobile Home_Hart (2) CLAIM FOR HOMESTEAD PROPERTY TAX I
' FORM=.1 STANDARD /SUPPLEMENTAL DEDUCTION YEAR
r ,' --z,• State Form 5473(R12/6-09) HC10
\, ,Y� ; Prescribed by the Department of Local Government Finance E 'INSTRUCTIONS:See reverse side for filing instructions. I�/ �,d '/i,,D„r /t�'n CERTIFICATIOMSTATEMENT. -
certify that I(we)occupied as N our principal
place of residence or a (are)buying the following described real property for which a Homestead Property Tax Standard 6cldytction is h. y claimed
under contract on the date this application is filed, (date of filing): O�(a(?/ iQ,S
❑ I(We)own ❑ Am(are)buying under recorded contract GIBBON COUNTY 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
- - _ _ •,.•CLAIMANT'S INFORMATION `
Name of claimant(legal name) - - -
Social Security number of claimants spouse(last five dgits)I Drivers license/Identification/Other number Issuing State
of claimant's spouse(last five digits)
•
CONTRACT RECORDED
-
If buying on contract,Fee Simple owners name -
Recorders office where contract is recorded Record number Page
•
. - ,. PROPERTY DESCRIPTION - -
County Township T. ' .d l city,awn,townshhii j�/
.� qu r
Pa nut r yn Legal description Is the property in question: zi
of 4d nutty,
'QOt'�OO I ❑Real property I4I Annually assessed motile home(IC 6-1.1-7)
Jd f anthe y portion property of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
o utif¢ed o produce income.
. ... .. , ,.PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES - - -
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature of di t •
Address grni m�,ber sd yreet,city,a and ZIP..e) )y `/ 4_ —�'', r��/J
. 061 ..-Y /fYl e:- ... O/r�7 /J!t /
ASSESSOR USE ONLY TRUE TAX VALUE I ASSESSED OF VALUE I HOMESTEAD I NON RESIDENTIAL
AT 100% TTV VALUE VALUE
Land not exceeding immediately r„ S' YT n surround ng residential improvements.met . (1) i
Other land (2) y
z r
(.-AT-a.417,:
Total land(line I plus line 2) (3)
Dwelling (4) -r'`�•'^t`g x';s ''s!: Yt{. ^t
Residential Improvements or Annualty + a °E.-n^c ?_r. �..
Aecassed Mobile I Manufactured Home Garage r -r e> >.:
r r
24 ,r-..-
Other Improvements (6) :aYSt t�;;k:44:.-_
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8) .
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete. a 1 \S\\� ,�I \t
Verifying action-Signature of Auditor I i { Date.signed(nronh.day,year)
(re
STANDARD DEDUCTION ALLOWANCE : -
20 pay 20 \\Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other,Bmvision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that is $
not assessed as real property or to a manufactured home that is not acmcsed as real property may not exceed
one-half(12)of the assessed value of the monde home or manufactured home.
Signature of Auditor Date signed(month,day,year) '
