Homestead_Slaton ',.r CLAIM FOR HOMESTEAD PROPERTY TAX ,- I1ta
1a STANDARD/SUPPLEMENTAL DEDUCTION !
i.p State Form 5473(R13/12-09) 1 O L `
Prescribed bythe Department of Local Government Finance ',r
�
INSTRUCTIONS:See reverse side for filing instructions. APR 0:9 2012
Wizd„�.:c21 st ".:i.•;itWaV'..Wr'" a.h. sCERTIF.ICATION'STATEMENT ::"='.?tr t„5. `f 4 ::rgaR€-`, s'' u'tlram > ; Y§. •'_
I(We) o Q. ' certify that I(we)ocai. :. . principal
place of residence or am(are)buying the following described real property for which a Homestead Property Tax Standard Deduction is,-•:•.4daimed
ter contract on the date this application is filed, (date of filing). I(We): GIBBON COUNTY AUDITOR
Own Am(are)buying under recorded contractAm (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.
n'i'. >: tt c µ- c,;y rx�a 1 E l t r -'$s"t` CL'AIMANT:S INFO(2NIATION f ,�r. ..,fir"' uTr r4�-`,t '� ri i':> • �g
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Name of dai t( I name)
%f, 5 /Qk
Name of claimants spouse(legal name)
Social Security number of claimants spouse(last five digits) Drivers license/Identification/Other number Issuing State
of claimant's spouse(last five digits)
;-e '- :Vic- .Li 12. rc FSt,k }{CONTRACTaRECORDEDK. `.r5....�..`2.ST'... it sn r `, x it t ,' 0 `2A
..�a�.Y7` .- -:..� .9 �. �:-:.t. vir-r�n'���� __ .. t.s'w.�._,.:i{ _:ems t 3 r ti:..s'�,:r.
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
IWC:t>v ck ....:y?zal.494- Z r-. 4g;11. At LP.ROPERTY.DESCRIP,MON,. i:.s.z rich x:-:.gLZ R'3raxc'-IViii ti l^X :
Township Taring (city, o township)y
County() !a �J Q �L/JC-f/eC�/.,
Parcel number Legal descriptionti //n /� / Is the perry in question:��,,....,,{{
Cif 6- a?-Lid d 7 s /996 CSC 7ti x-' l property Anna%assessed mobile txvre(IC 64.1-7)
If property of the to �istructure the land not exceeding one(1)a that immediately su nds that structure is u to produce income,describe the use and portion
the
411
1 „sgt-awie r.,.-,ys� ---it ro,,,yD;? PROPERTYOWNEDBYCLAIMANTINOTHER'..000NTIESv :yo -'y -m:N ,,g-tr ,`.z_ -/iza,,`. :
County Township County g Township
cliI hereby certify the above statements are true,correct and complete. of claimant A m
lVp
• (number and sheet city,state,a ZIP
4,5i S IFri netiOn gN `I (,7p
K F.>':4;:;i rASSESSOR Uslu zit 6 :,al ,TUE T ALUE ji AAST E 95E,opD VALUES HOMESTEAD ��z' '„# NON RESIDEN IA0-5A,v
Land not exceeding 1(one)acre Immediately (1) Fin _ YN, ,..-•,� " - 4—
surrounding residential Improvements. - * .� ll
c .:4 .
ifrl
Other land (2) ..a z' ,ta:r_ :
Total land(line 1 plus line 2) (3)
.lL C 0 ,t W i{ r4
Residential Improvements or Annually Dwelling (4) +. a -� r ��'t.;+y-
Assessed Mobile/Manufactured Home Garage (5) t40- `_r -! �f
Other Improvements (6) ; 'f".^yr
Total improvements(line 4 through line 6) (7)
Total value pine 3 plus line 7) (0)
1
I hereby certify the above Is true,co ,• Signature of Assessor �1 Date signed(month,day,year)
and complete. t \1 /, Iy
Verifying action-Signature of Auditor \I ( \) �� \ \) U \1% Date signed(month,day,year)
®-y+ _r S7"• 'v -Ts-y. - P ; t� tti'>.$ AND•RD'' ' ION:.LLsn ' 1 y.xr�,;.' :T.r ici y-1 e :.r,' y,,,4 ..rq{
3 . ,..r*_...1ht...r1,.._........_b � .�2z.3Y+.d..___ .__. .. . . -.. .1.- ._.._-. _.....a ..i:.. r.�rVra<.?r.e:o_._�.x,_. ...�:_ .� .
20 pay 20 Lesenr of 60%of the assessed value of the homestead or$45,000
Notwithstanding any oherpovisun,the sum of the deductions provided in IC 6-I.1-12 toe mobile home that is $
not assessed as real property or to a manufactured home that is not assessed as real property may not exceed ---
one-half(12)of the assessed value of the mobile home ormanufactured home.
Signature of Auditor I Date signed(month,day,year) .___