Mobile Home_Sokeland CLAIM FOR HOMESTEAD PC TAX �,FERC1( 1__11,
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y,Z•I CREDIT/STANDARDDEDUCTIONRO Y �( J
R', State Fonn 5473(R8/7-07) 1
Prescribed by the Department of Local Government Finance �C. A AUG 1 I� � � 200U4
INTR SUC"°MV-•See reverse side for filing instructions. /
.,.s `, ?p t:.;.{ sr F^,.' . `:/•. . ,.•,,, ,-CERTIFICAT'IONYTATEMENT:'.i- t•s v .•.'•. :-' - � s�t- ;->. .9,"•
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I(We) /(°�( oh Pa- ' GIBBON C0�1 yTY AUDITOR
Q. certify that on the 1st a of March, 20
I(We)occupied as our principal place of residence the following described real property for which a Homestead Property Tac Credit is hereby claimed:
(��' I(We)owned ❑ Are buying under contract
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 contract.
_ _ .. _ _. i.; - . , ^CONTRACT RECORDED,. -- s s _ �>- `7,
It buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
V- t ` r -}r,. , r , r r `. . .''PROP,ERTY-DESCRIPTION .?c:t - t .. ..c.=-•._",*
C N TamshiP T `n • Imvnship) tent)
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Pa um er Lega ee rinption Is the property in question:
/ 1 'l OQ 40 /Va l�,( c��XQ� 0 Real property Mobile Home(IC 6-1.1-7)
any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to prod income,describe the use and portion
of the property utilized to produce income.
7- ;tx:a.:1t,.J,_sr )t..n'ia_•r ,x. -. ! ,;C:PROPERTY,OWNED'.RY:CLAIMANT,INOTHERCO NTI UEs . _ fr:Ti.".1f.:7i -i-1"!?:"...±::;:t:',..,71.
County Township County //7 s Township
I hereby certify the above statements are true,correct and complete. ,/Signabr f e nt yL.e�L `
'fes1P code)
ai=75�/l r and street city state.an�R/C x% � .- J
S 4�7G1�
�?T(j�a�ASSESSOR USE ONLY t<4 Y I TRUE TA%VALUE IAAT E00/o OFATTV 1H�VALUE ADr " "JO4.VALUENTIAL *
Land not exceeding 1 (one)acre immediately -_
surrounding residential improvements.ents. (1)
Other land (2)
Tctal land(line 1 plus line 2) (3)
Dwelling (4)
Residential improvements or Annually "- ``r`• T
Assessed Mobile/Manufactured HomeGarage (5) - i -
Other improvements (6)
Tctal improvements(line 4 through line 6) (7)
Tctal value (line 3 plus line 7) (5)
I hereby certify the above is true,correct,and Signature of Assessor Date signed(month.day,year)
complete.
Verifying action-Signature of k itor 1.-) \1 \,1 \I Q Date signed(month.day,year)
\ t)/s4i_;3.„N= r •• t4;f", _ ;,�.:.r V STAND.'lRD DEDUCTION'ALLOWANCE , x , . � ::`:, ct -;1='
co_pay 20_ 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser o11/2 44.000 for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead Valuation S
or 43,000 for 2039 pay 2010 40,000 payable after 2012
Signature of Auditor Date signed(month,day,year)