Homestead_Selby re 1., CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORMHC1 2o27— ,
.���� . State Form 5473(R18/1-20)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) 106 7 a - II certify that I(we)occupied as my(our)principal
place of residence/or am(are)buying the Bing described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
❑ Own. O Am(are)buying under recorded contract.
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
El 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.
CLAIMANT'S INFORMATION
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
County ^ Township I Taxing district(city town,township)
,,) � • ` Legal desert (Is t property in question.
Parcel number `/ p I
Real property ❑ 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 ds at structure is used to produce income,describe the use and portion
of the property utilized to produce income
26 _ k 'S _2(--1 _ 2 °) _p0O Zsl —026
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is c i ant vacating a homestead?
Yes ❑ No
Si•tiii re of claimant
I hereby certify the above statements are true,correct,and complete. / I
i , ..
Address of contact(number fir ef.city state.and ZIP code) A.dre a fed homesteait if any(number and s re .ci state.and ZIP code)
14 C-c4lv.VD- S� \=A-`�,0�6,-O tI o E oh ,, st V) -3 -yam; ,
ASSESSOR USE ONL, I ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
(J VALUE
Land not exceeding one acre immediately
surrounding residential improvements
(1)Other land (2) f <• ._'- - � '. ___- Or
SA� N
Total land(line 1 plus line 2) (3) F G tT
Residential improvements or Dwelling (4) - _ 7l V
annually assessed mobile/manufactured home Garage (5) _ .. (VI
Other improvements (6) 1 -1,-1 r '` • ^ •- --�
1
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6) ft�•e',++'^��- c.."
Signature of Assessor
GIBBON COUNTY AUDIT Date signed(month,day.year)
I hereby certify the above is true,correct, 1
and complete. I
Verifying action-Signature of Auditor Date signed(month,day.year)
C
STANDARD DEDUCTION ALLOWANCE •IN
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000.
6
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 reel property or to a manufactured home that is not assessed as real property may IC
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor- Date sign month, Z-�
pitil
X.....
DISTRIBUTION: Original-County Auditor. -Vamped Copy-Taxpayer
gins
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