Homestead_Hidbrader eel��� CLAIM FOR HOMESTEAD PROPERTY TAX YEAR I \J
( �� STANDARD/SUPPLEMENTAL DEDUCTION i FORM --
;/ State Form 5473(R 19/1 23) HC10 Z
r Prescribed by the Department of Locai Government Finance
INSTRUCTIONS:See reverse side for filing instructions o(6
NOTE:Telephone,Social Secunfy,driver's license.state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) tC VIAC \a bra.er certify trial 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. M/27/.2,11 (date of signature) I(We)n ❑Am i.are'buying under recorded contract
0 Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
0 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
If Buying on Contract.Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number I Page
PROPERTY DESCRIPTION
County Township I
III) -axing District(city tovm.township)
►b5on ' I-lo..)dsia,sli-
i Parcel Number Legal Descriptio Is the property in question
,PIt- 18-36- Lib 9 -MO, (i g0 -WI Eriral Property 0 Annually Assessed Motile Horns CC 6-1 1-7)
if any porton of the residential structure or the land not exceeding one(1)acre that immed,ately surrounds that structure is used to produce income describe the use and portion
of the property utfized to produce income
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County.and Township Is Claimant Vacatingng a Homestead/
'/ I ❑yes L2'No
r •3uma^t
I hereby certify the above statements are true.correct,and complete ,nAIi / W�. Ill ' ii 11 e
Address of Contact number and street,my state and ZiP code) =J Jr s of is ,t mestead.ifany(number nd s - t city..late and lP code '/J ��
IV( , • .e �r x ..b 1L . a-IJ N76 " ��.► L •L i x1 i /{]7
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE ' NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1) i . ! P6
Surrounding Residential Improvement _,
Other Land (2f
1
1 plus line 2) (3)
— 1
Total Land(line FILED
Residential Imp rovements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5)
•
Other Improvements (6) FEB 2 3' 2024 --
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) I(8) y9_ a 1
Signature of Assessor GIBBON COUNTY AOR month year
I hereby certify the above is true,correct,and complete
uDrr
Verifying Action-Signature of Auditor Date Signed(date month.year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or 548 000
Notwithstanding any other provision.the sum of the deductions provided in IC 6-1 1-12 to a mobile home that
5
is not assessed as real property or(o a manufactured home that:s 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 Aud for Date Signed(month.day year)
L - JVI - iiklidkAr2 - 61 -- a3/a`f
DISTRIBUTION: Original-County Auditor File-Stamped Copy-`axpaye'
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