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Homestead_Beck STATE FORM 5356 (R1 7-011 TREASURE,FORM IS-IA APPROVED BY STATE BOARD CC ACCOUNTS.'WS PRESCRIBED BY THErARTMENT SW LOCAL G0WRSIFAT FL\AS1ZE C .t122-B1 IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud causes higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the benefit and to provide additional indentifying information necessary to allow county government to better monitor homestead filings. This information will be kept confidential and can only be accessed by authorized county officials. The Department of Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud. PART I: PROPERTY INFORMATION Property Address(number and street,city,state,and ZIP code) 30ki 1p ) , 81013 State Parcel Number o I 7 1 lD- I3- 1 3 -4105- oco. o7 5 -oa �, GISON COUNTY AUDI70R l3 PART 2:TAXPAYER INFORMATION Owner I , First Middle Last II II G� Irnberl - zyNN Mailing Address(number and sire`,,city,state,and ZIP code) ame as property address Spouse First Middle Last Mailing Address(Number and street,city,state,and ZIP code) tS.Samt�as property address Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below) Scats PART 3:CERTIFICATION Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions unlawfully,he or she may be liable for back taxes and substantial financial penalties. I ne I Signature Date FILE OLI 162013 INSTRUCTIONS M p a �. u. ✓ GIBBON COUNTY AUDITOR �� '�`�°4 CLAIM FOR HOMESTEAD PROPERTY TAX ;��= CREDIT/STANDARD DEDUCTION. � .�;;�� State Form 5473 (R2 / 5-92) au INSTRUCTIONS: See reverse side /ar liling inst�uctians. . FORM YEAR .. _ `p � � ( � - i.�nnni.H��vrvainicm�ni � �� � �We) — - � .. . . . . . . . certity tha�wy��qfe1y Tof/1p � e) occupied as our p cipal pl e of residence the tollowing described�reai propertyfor which a Homesiead Pmperry Ta�K¢eac�i! Ct�f�b daimed: II I I(We) owned ❑ Are buying under coniract � � Have a beneticial interest in the entity that is liable for the property taxes on the property and ihat owns the property or is buying under a contract. � . � ' CONTRACT RECORDED • It buying on contracC Fee Simple owner,'s name • - .. . , . • Recorder's oHice where contract is recorded Record number Page � County PROPERTY DESCRIPTION , . Ta�cing �iS�riCi ciry, wn. townShrP) pl1- 000�5 � ��� 13-3-II ,3� �Cr If any portion of Ne resitlential strucmre or the land not enceeding one (7) acre that immetliately surrountls that siructure is used to produce income. describe the use and portion of the property utilizetl to protluce income. . ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENT1Al VALUE VALUE VALUE VALUE . Land not exceeding 1(one) acre immediately surroundingresidentialimprovements.� (�) � Otherland (p) . Total land (line 7 plus line 2� (3) Dwelling (4) Residential improvemenis Garege (5) Oiher improvements (6) Total impmvements (line 4 through line � (7) Total value (line 3 p�s line � (g) I i hereby certi�y lhe abOVe is true, correCt. and Signature ot Assessor Date signetl complete. - � ' �rying action - Signature ot Auditor Date siqnetl 19_Pay19_ Lesser of V2 Homestead Valuation or 52.000 I� Sgna r of Autlito(� . (� _ `� ..; i STANDARD DEDUCTION � _ � �� I � ' \ 5i9^ed � �= � a-4- - � - .