Homestead_Jacke CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
' ,� STANDARD!SUPPLEMENTAL DEDUCTION FORM
...l' �fi
,x �s�r State Fonn 5473(R17/1-16) Ht;•10
�� Prescribed by the Departmental Local Government Finance
INSTRUCTIONS:See reverse side for fifing insttu 1"•.•
NOTE Telephone,Soda!Security,drive -,..-nse,state idenfffrcaton an, era:Identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) I arAII l/!_ �l�./ . certify that I(we)occupied as my(our)principal
place of residence or am - b• .r-.• •6i real property under contract for which a Homestead Property Tax Standard -
De&lion is hereby claimed o`1 - •-e this a plication is signed, (date of signature). I(We):
r fd own. 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.
•
Recorder's office where contract is , Record number Page
111.
PROPERTY DESCRIPTION
en '` Township Taxing district(city,town,township)
P n•` L:egaldesaipton Is a pertyinquestion:
Real property 0 Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surro s th structure is used to produce Income,describe the use and portion
of the property utilized to produce income.
2 6- 2_0 - 3Z-300 - 0o p 5 S --OO 1 .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No '
Signature of dui •• —�
I hereby certify the above statements are true,correct,and complete. y„ i I .'/r/
Address of contact(numberand sfreet,city,stale,and ZIP code) -.p d homestead,if any(number and sheet dry,-,,_, •-Zf--••e)
• Ct S_.�21�r.C 1 i ' ' . -i 1 - .
ASSESSOR USE ONLY ASSESSED VALUE 11 1 HOMESTEAD VALUE I NON RESIDE" 'AL
VALUE --(/�� 1
Land not exceeding one(1)acre Immediately = c ' v ` •
surrounding residential improvements (1) ._,:. _ ....
Other land (2) ,
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) r r _
annually assessed mobile!
DEC -- 1 ,
manufactured home Garage (5)
Other improvements (6) 'T , r,,,-g t iI
Total improvements(line 4 through line 6) CI) ` , lT OR
Total value(line 3 plus line 7) (6) GIBBON COUNTY
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Notwithstan• • - Ether provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not a -.as real properly or to a manufactured horn is not assessed as real property may
not exceed o- , 1/2)of the a e ed value of the mob ome o anufaclured home.
Signature ofAudrto, Date signed(mo day,year)
1 \ l/ tt (q ,
DISTRIBUTION:Original-CournyAuddor,File-Stamped Copy-Taxpayer ,
Page 1 of 2