Mobile Home_Walls ,AlCLAIM FOR HOMESTEAD PROPERTY TAX
t STANDARD /SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R13/12-09) HC10EI
s ! Prescribed by the Department of Local Government Finance I.. I i I_
1 I ti
INSTRUCTIONS:See reverse side for filing in-(ructions.
_ 27 r0 - ) ' / . - o CERTIFICATION STATEMENT - • ,
I(We) grje//6 s certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property for which a Homestead Property Tax Standard dudio - h med
under contract on the date this application is filed, (date of filing). I(We): GIBBON COUNTY AUDITOR
illOwn ❑ Am(are)buying under recorded contract
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
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
ti 7.jir 1itt.: 9'-`. -::. CL•'A ANTS:INF_ORMATION,e:-,2.y '';. -" - t: . . -
(,
Social Security number of claimant's spouse(last five digits) Driver's license/Identification/Other number Issuing State
of claimant's spouse(last five digits)
•
. . _ e 5 r.. . . _ _...:CONTRACTeRECORDED—___ _. �.._ ,�. :a_"T . . t _ -
If buying on contract,Fee Simple owner's name
Recorders office where contract is recorded Record number Page
.I
_ -, .PROP,ERTYDESCRIGTION - q - -`..,
County TownshipFp cl( to. .town
,)C.) i
_ifXI num•-- ^ �1 l,�J •f �lLegal description Is the property in question:
— ' a'/ (/��l�6Oc—t,l� ❑Real property malty assessed mobile home(/C 6-1.1-7)
If any portion of th/e residentialJ structure or the land not exceeding one(1)acre that immediately surrounds that structure is used thTprdluce income,describe the use and portion
of the property utilized to produce income.
II
a-C�. - - 1PROPERIMP ENW D BY,CLA NIA"NT IN_LOTHER COUNTIES,.- __
County Township County Township
Signatre of claimant '1 3i `
6 I hereby certify the above statements are true,correct and complete. ]�l`YVr ig"1�h. `('((JJZ
•dress(number and street.city,stet:,an•ZIP code
S4- ' Ti 'r n • . / T '-710 0
ASSESSOR USE ONLY 1?RUE TA7(VALUE I'QSSESSED;VALUE HOMESTEADI NON-RESIDENTIAL
. 1-rra--_sn.r. °L,ATh100%,OF�TN�I� VALUE -.VALUE ._
Land not exceeding 1(one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Dwelling (4) '
Residential improvements or Annually
Assessed Mobile/Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6) -
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete. ,1
Verifying action-Signature of Auditor \`� 11I I(l Date signed(month,day,year)
_ - . . - 'STANDARD DEDUCTION ALLOWANCE _
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that is $
not assessed as real properly or to a manufactured home that is not assessed as real property may not exceed
one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)
