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CLAIM FOR HOMESTEAD PROPERTY TAX
A' ^.� �- STANDARD / SUPPLEMENTAL DEDUCTION FORM
.'��1�y� Sta:e Form SaD (R15 / bt<) HC70
�-• ;���' PrtunEWEyNeOeparmentc:loalGwemre�vFVUnce
INSTRUC710NS: See reverse sitle for �i6ug lns✓uclions.
NOTE: TNeuhone. Soda/ SewnN. tlriveYS Gcense. sfale itlenti;calbn aM lederal itlenlifxafmn numbers ara confdenlial un0er IC 67.1-
I(VJe) A.. /" ..oJ certify that I(we) oauPied -eS�+�Y (� PS
place of residence or am (are) buying N Ilaving described real property under contraa for which a Homestead Property Tax S�
Oeduction is hereby Gaimed on the date this application is signed, (date ot signature). /j}V�:
vl,
❑ �,vn. ❑ Am (are) buying under recorded conVact.
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a benefcial interest in ffie Wst or the right to occupy the property under ihe tertns of a qualified personal enc¢
❑ Am (are) the shareholder, partner, or member of the en:iry lhat ovms the property. (�jJBSn�� _
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Rem(defs o3m wMm romna is recoNed
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Grvers&enellEefG.Ya•vonl �ernunEer Isuvg�
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DrrvmiGcenx/IOercufralion/
Recwtl mvnEC Papa
� Tadeg EsY (a. , lown. lw�Wry) /
tta�rypwu rtsaentuis�cturewm�iafwmteacsauqone(�)aaewtnv:�cow
oi me pope ea ro proaum income.
o?�-i�-a� o3oa_ o% �s�'-ooz�
I hereby certify the above statements are we, conect, arM comple;e.
1CCress N wntaC (numDer erN.Vrcel. t'ity, 5ate. erd ZfPwOe)
Zlil S. .�n.ri S�reet ��ncelon.JN
LanA not eaceatling one (7) acee immediatety
SUROUI1tlIng �BSIEBnlial impfovem¢lli5
Otherland
Total Wntl (lina 1 plus line 1)
ResiAantlal improvemen6 or DwelOng
Annualy Assassatl Mobile I
M1lanutacNred Home Gaage
Oth¢r improvements
Tobl improvements (line 0 thmugh line 6)
Todi value (line 3 pl(c line n
1 he�eby certity Ne above is We, correc;
(1)
(2)
(3)
(4)
(5)
(6)
(�)
(8)
Simuane otAxussw
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�ceRY ❑' Amua%asusSeC moCie twme (1
yry�s usetl �q(�atlue'ucane, EesoiEe Ne u5e aM
Is tla'unantva�yg a
� Yes [] No
d aM (�^�� � �L �Y. stab.
20 _ pay 20 _ lesserof 60% of Ne assesseE v�ue ot ihe homesteatl ar Sa5,000
Ab�w:hsfand'uganyoNerproNSlon,�hewmolNetletlucGOnSprovitleOinlGGf_1-f2roartabilehome 5
Naf i5 raf asseisetl es realpmperty w!o a manufaUUred hmre Nat is rrot assessed as iealprppeM ^�Y
not e:ceetl ona-hatt (f/1) ol Me assessetl value of fhe mod7e frome w manNartured home.
sy� ma,o.:�
oisrwaunoH: o�q�vi-cwnrynwro.,Faes mpeacooy�ruwrn
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31 1s
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