Homestead_Harvey (4) oY—qq
/5 . CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
44STANDARD/SUPPLEMENTAL DEDUCTION
itioState Form 5473(R 19/1-23) L HC10 aod3
Prescribed by the Department a'Local Government F,nance
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) NI VI S aNe"\ certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date�,/this application is signed, to/I o1/Q 3 (date of signature) I(We) /
L�Own ElAm(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
CONTRACT RECORDED 0
I Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
4
PROPERTY DESCRIPTION
County Township N1 Taxing Distnct(city.town,township)
tb5o✓� /ram er`� 1
Parcel Number1 Legal Descnptw`n .t �—� Is the pro rty in question \�
9(0• \O-a5—a0Q—-7os—?�L T(�.a\ eat Property ❑Annually Assessed Mobde Hone(IC 6-1 1-7)
If any portion of the residential structure or the land not exceeding one(II acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income k
1
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is C m nt Varatinn= tead9 1
Ves
-
•WIV ..".2 ( _)
1 Sig .t.of C;ai i- O
I hereby certify the above statements are true,correct,and complete
i
Address of Contact(number and street,city slate and ZIP code) Address of Vac e.Home tead,if any(number and street City,srate�rl�i4Pao�el
( Ctq S '1S • �NQ�Sv\\.\Q rJ 976 ' 5
ASSESSOR USE ONLY ASSESSED VALUE 1 HOMESTEAu VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1 j I 0
Surrounding Residential Improvement f
Other Land (2)Total Land(line 1 plus line 2) (3) ] 'i[Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5) — - OCT l ���
Other Improvements (6) Lil
11
Total Improvements(Line 4 through Line 6) (7> , /�j L
Total Value(Line 3 plus Line 7) (8) ,�� a.liAYI�L�I�.�e.,:,koo 1
Signature of Assessor GIBBON COUNTDYte'9rtdrev(o l lwionth,year)
I hereby certify the above is true,correct,and complete. A,
Ventying Action-Signature of Auditor .Date Signed(date month,year) l�I
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000
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 property 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 mobilehome or manufactured home
Signature of Auditor/r, ■_ 1 ` iti��` ,►y Date Signed(month.day.year) _ _. ___ _
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
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