07/28/2015 - Laserfiche WebLink

Home Browse Search

� ' FORM Nebraska Departmental Nebraska Homestead Exemption Application or Certification of Status REVENUE • Nebraska Schedule 1-Income Statement must be filed with this form. 458 File with your county assessor after February I and by June 30. Please Do Not Write In This Space Please Type or Print County HALL Applicant's Name and Address Applicant's Date of Birth(Mo/Day/Yr) Applicant's Social Security Number CONNIE OLIVO 02/10/1930 506-26-0769 • Spouse's Date of Birth(Mo/DayNr) Spouse's Social Security Number 410E 11TH ST GRAND ISLAND NE 68801 Legal description of homestead or location and physical description of mobile home: RUSSEL WHEELERS ADD E 1/2 LT 7&W 3'LT 8 BLK 37 Filing Status 0 Single ['Married or Closely-related If you were widowed or divorced since Jan.1 last year,answer the following: Spouse's Name: Date of Death: Date of Final Divorce Decree: Homestead Exemption Categories •Nebraska Schedule I must be filed for all categories except Numbers 4 and 5. •See instructions on reverse side for specific regmtemp 1§,, 1 •1 Qualified owner-occupants age 65 and over. JUL //�j 2❑Veterans totally disabled by a nonservice-connected accident or illness(Annual certification is required—Form 458$or VA celtifi&�)S 3❑Disabled individuals(see restrictions and instructions for certification requirement). Gt+k / 4❑Veterans drawing compensation from the Department of Veterans'Affairs because of 100%service-connected disdbittor.the unremarried widow(er) (VA certification required;see instructions for certification requirement). 5❑Paraplegic veteran or multiple amputee whose home value was substantially contributed to by the Department of Veterans Affairs(annualVA iterbGeation required). 6❑The unremarried widow(er)of a serviceperson who died while on active duty(VA certification required). 7❑Individuals who have a developmental disability(Form 458B is required). If category 2,4,5,or 6 are checked above,enter veteran's service dates. Veteran's Service Dates Beginning and Ending , (Month) (Day) (Year) (Month) (Day) (Year) I Do you currently own this residence? AYES ❑NO 2 Do you currently occupy this residence? YES ❑NO • 3 If you or your spouse are currently residing in a nursing home,please answer these questions: I •What date did you or your spouse enter the nursing home? (Mo/Day/Yr) • Have the household furnishings been removed from your residence? ❑YES ❑NO • Is the residence currently occupied,leased,or rented by another person? DYES ❑NO If Yes,who is residing in the residence? 4 Is this homestead owned by a trust? ❑YES •'4 NO • If Yes,are you residing at this homestead as a beneficiary under the trust instrument? ❑YES ❑NO 5 If you received a homestead exemption last year,is the preprinted information on this form complete and correct(names, Social Security numbers,birth date,marital status,exemption category,other owner-occupants,etc.)? XI YES ❑NO • If No,please indicate the correct information in the appropriate area. Other Owners Who Occupy The Residence(Attach list if necessary.) •Nebraska Schedule 1—Income Statement must be filed for each owner-occupant(DO NOT repeat applicant and spouse.) Name Relationship to Applicant Date of Birth(Mo/DayfYr) Social Security Number Under penalties of law,I declare that I have examined this form and that it is,to the best of my knowledge and belief,true and correct.I also declare that I am entitled to the Nebraska homestead exemption and have not applied for a homestead exemption elsewhere in the state. $1I am a citizen of the United States. ❑I am a qualified alien under the Federal Immigration and Nationality Act.My immigration status and alien number are as foil ws: p and I agree to provide a copy of my USCIS o umentation upon r uest. sigq na�=� c B - '.�� -,05)--/6 her Signature of Applicant ate elephone umber FOR COUNTY ASSESSOR'S USE ONLY are alion bar /q Tax Distn'cLdymger CurrenF95�sse (t stead Property ❑Approved Comments: `•rte y - <C) X+%Ic 1 C; :•`{rJ✓. 1 n_� — .. -es .'. .frgpisapproved .: �'. . r s __ s _... Date Received by Cou y Assessor Signature of o m • essor Date Nebraska Department of Revenue File with your fi• n assessor otter February 1 and by June 30.Authorized by Neb.Rev.Stat.§§77-3510 and 7?3528 Y nty rY Y Form No.98-295-2009 Rev.1-2015 Rind with soy ink on recycled paper "etaln a copy for your records. Supersedes 96-295-2009 Rev.1-2014