Homestead_Lloyd (12) t4- CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
�, t, STANDARD/SUPPLEMENTAL DEDUCTION OR
`ri; State Form 5473(R13/12-09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
ill.
y a z: aiia } fit CcRTIFICATION'STAEMIENTy-a tj&l La 'a'-"n
Pn irE
I(We) IaTirstng-/!'!/LI_r certify that I(we)ocalpied as my(our)principal
place of residence or am(are)buyilthe following de-cribed real property for which a Homestead Property Tax Standar0 aedlrlt)gn is hereby claimed
under contract on the date this app ,ction is filed, (date of filing). I(We): J ajar��VV 1 1S Cll(4
❑ Own ❑ Am(are)buying under recorded contract I�+r'` . rt '�
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation S n`u"„`”7,'r ^^^
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qua W$ rfaniThilirlbdf1tatITOR
❑ Na(are)the shareholder, partner or member of the entity that owns the property.
yYT:C` c .s5 .,, ' i tit •'t.. .y :i - :� .E3.,a w�--- f.TAril..� y lli Y k ": �{. t.:_ .yy._.
-r ri4,a_ +�-....,.:�y 'y.. CLAIMANTtSiINFORMATION - SJ..c 'sa'a::t3ai.'1�"':,�'Y,wau�5:..... �t+.f.
uvrsifa3Fe.�.�Jt -thy.:��:�at�: :� �.�'.re�'.Lr4�•s+.d +ter.
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number
Page
„-W �s r ain � vga.4 � OPERY DECRIPTI151∎1 i rN712'a L ?