Homestead_Moskos�
OCLAIM FOR HOMESTEAD PROPERTY TAX
b STANDARD/SUPPLEMENTAL DEDUCTION
State Form %73 (R72 / 609)
' � Preunbed by Ne Depanmem of Local Govemmeru F�nce
� � � YEAR
HC70 �
DEC 2 0
C .'J.
INSTRUCTIONS: See raverse side !or fifirg inshvcfions. � .
. �
I(We) cerliry that I(we) occupied as my (our) prindpal
place ot residence o m(are) buying the ollowing described real property for which a Homestead Property Tax Standard Deduction is here6y daimed
ruXnder contraG on th date this application is filed, (tlate o7 filirg):
u I(We) own ❑ Am (are) buying under recorded wntracl
❑ Am (are) entiUed to occupy as a tenant-stockholder of a coopersGve housing corporation .
� Have a benefidal interest in ihe Wst or the right to occupy the property under the tertns of a qualified personal residence wsf
.• � .
� •'� �
If Wy�g on oontra� Fee Simple ownefs �ma
Remrdefs ofice where conUac[ is recorEed Record number Page
..�. . � . �
Counry Township Tezvg 0' (Ul: town. lownship
ParW number Legal desaiptbn . (/ Is ihe pmPeryin question:
ri�.f_
/�Nc� � Real Wo7eM ❑ MnwBy asussed mod'le M1ome (IC bf. f-7)
II any portim d Ihe residentlal sbucWre w the WM not e ing me (1) aae Nat immediatGy surtoufMs Ihal strucWre is used to yodwe 4imne. descnba the use an0 portion
ot ihe prape ufif¢ed to PmOuce inmme.
a� a�-/�f- 300. r�o�. s�s_o�t s�
-.• . ,: . .
Caunly Townr,hiP CwmY Townstup
I hereby certiy the above stetements are We, correct and complete. Signamre of daimam �
�i
AOAreu(rwmberandatreet,ary,stata,arMZIP�° e) �
� S. ' U- : f:u ' f % c3
� � • � • �
• • ��' �
Land not ezceeding 1(one) acre Immediatety • -`�i. ��,�i ��, 3'�+',,,'�'-�*'` -�
sunoundin resitlential im rovements. � �» i'��.�_Yr�'-`.'�r-r«-.��:_+
Other land (2) ��v��'"
7ota1 land (line 1 plus line Z) (3) �
t .� � �.��''K 3 .�`,
ResitlenUalimpmvemenfsorMnualy �Iling (4) ' �_'�r��Yx''�'.#E;�,a��.��
0.ssessed Mobile / Manufactured Home ��.s�� �3x-�'au�?r,�§��f�;'r',�,7""'ti:
Garage i5) cE':!:: T'<�.a,� �a,."�'i`s��p �.:X
�.� �t�����
Other improvemertts is) ;3��;.��„�`,� s;.;,'-'r-�:
Total improvements (llne e Mrough line � (7)
Total value (Ifne 3 pl�s line 7) (8)
I hereby certi y ihe above is we, correct, Signawre ot Assessor . Da[e slgnea (manrh, eay, year)
and complete.
VeriN��9 adion - Signabna oflu�ditw Date signetl (rtron1A. daY. Y�1
�.-� � � • •
20 pay 20 _ Lesser of 60 � of the assessed value of lhe homestead or $45,000
NWxNhstaMbg anYWherpro�.ision. Ne sum W Ne deductians proviCed in IC 61.7-12 ta a mob8e Ipme Nat k $
mt essessed es real properry w!a e rrenu/aGUred hart1e fhat is nof essessed as 2al pioperty may rmt exaeetl
one-nan ryrzJ d me assessed rehre wure rtioeae nortre or rnanulaau�ed narie.
Sigriature N AuNtw_ � Dafe signed (month. daY• Y�
`_