Mobile Home_Jones ..f i�: CLAIM FOR HOMESTEAD PROPERTY TAX FORM ' 109 I YEAR f
CREDIT/STANDARD DEDUCTION
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Slate Form 5473(R817-07) a,,,, (,
Prescnbed by the Department of Local Government Finance
GIBBON COUNTY Atj I��
INSTRUCTIONS:See reverse side for filing instructions.
- - . . CERTIFICATION STATEMENT - - - -
I(We) / 411–.....0.– i JJ sae •.i1r1 ., certify that on the 1st day of March, 20_
r M'e)occupied as our principal place of residence the f .wing described real property for which a Homestead Property Tat Credit is hereby claimed:
ii(We)owned ❑ Are buying under contrail
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a W t ct.
•
- c-
- - CONTRACT RECORDED - - - -- -
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
- PROPERTY DESCRIPTION - .
County Township Tad a •4;'•• scat,town,township)
41
Parcel number �yt (`[[ ,,.+, Legal d riplion Is the property in question:
d C o , -l;y W.3 T 7 -`v / 7 O I tpr Real property ❑ Mobile Home(IC 6-t.
If any portion the residential structure or the land not exceeding one(1)acre that immediately surrounds that st/ucture is used to produce Income,describe the use and portion
of the properly utilized to 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 daimon rn
ak.nr.dress(number and street city,state.and ZIP code) W W rI
co I o W LA.)ayvt,azA - B-/3 Y( is aZwr t/7/o 7v
t l ASSESSED VALUE I HOMESTEAD. NON-RESIDENTIAL
ASSESSOR USE ONLY I TRUE TAX VALUE'i AT 100%OF TTV I VALUE VALUE •
Land not exceeding 1 (one)acre immediately c 's" <.Yo f 4^r_ n -:
surrounding residential improvements. (1) L3;. :- ::*,; .i„=..-.. ,.' :: ,
Other land (2) r -. -
Total land(fine 1 plus line 2) (3)
z :r t 4z s
;
Residential improvements or Annually Dwelling (4) 5dv} fir ( ?
v .,
Assessed Modle/Manufactured Home a fgi' t`' AVI;;{�''- 4;
Garage (5) a.-.
ofw 1;
'
Other improvements (6) � 2 :a- 'd
Trial improvements(line 4 through fine 6) (7) j
Trial value (line 3 plus line 7) (8) ,
I hereby certify the above is true,correct,a Signature of Assessor Date signed(month.day,year)
complete. //�� \ ,
Verifying action�\tur of Auditor \ 1� `, \\,\lrte f1 I Date signed(month,day,year)
® \. `STANDARD DEDUCTION ALLOWANCE -
20—pay 20_ 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 12 44,000 for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead Valuation $
or 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor Date signed(month,day.year)