Homestead_TrappCLAIM FOR HOMESTEAD PROPERTY TAX
° ' STANDARD I SUPPLEMENTAL DEDUCTION FORM
Sa:e Fam sa]3 (R15 / Sa4) HC70
•�' PreunDetl by Ne DepaYUnen� ol loral Govemmer.t Fwrcn
INSTRUCTIONS: See reversa siCe tor btirrg instmctionx ��
NOTE: Teleohone. SatlalSecunN. arivers license. sfafe i0enu:+cauon and feCe21 idenuficeGOn numbers am confdanlial under l�f-
I(We) " certiry that I(we) ocapied a�Q�➢ �u
place of resitlence or am (are) buying Ihe following described reai property und nVact (or which a Homestead Pro�}ty�Ta�
Deduction is hereby daimed on the date this application is signed, (date o7signatu2). I(VJe):
� Oan. ❑ Am (are) buying under recorded conuact.
❑ Am (are) entitled ro occupy as a tenant-stockholder of a cooperetive housing wrpora5on. (� pc
❑ Have a benefidal interest in the Wst or the nght to omupy the property under the tertns of a qualifi�8�pe1S� ��I
❑ Am (are) the shareholder, partner, or member of the entiry that owns the pmperty.
Namerjtlair.ant(/� �
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som 5caa::i �cnw o� aan,am Pas rne ayss�
rame) �"
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SodalSw�r.rynum0erotGa'unantsspouse(la4frve �,
II Gry4g w conVaq Fee Svnqe avmefs name
Rewpe(s c� xtere mn•saG is rem�tleE
�m4Y � T�^'^sM1P
of da4nam (U5 Me eyasl
ot tla: a'ns sp�wwse (lasf five �g3s)
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tw�n.
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Page
zl rninher nI Lepal CesmO� '� .0O /.�� la tlre ProG�Y in Gues.ion:
rl T Z� N W ��^ 3' �' ❑ Real G�RM ❑/w.ua%asussed moEde none
ry porton ol Ne resMeff 1 c•u�[.ture or tlie IdM rot ezceeEig one (1) aae Nat 4nmetlia'.ety wrtWMZ llut s'�utlure is use0 to ptotluce'vmne, EezmEe iM uu a
�e o�rerY vdxea ro o�um vmme.
o��o-ls-a$_ �oo-oo,Z.o�t�-o,t,j
Couky.anOTOwnsNp
I hereby certify Ne above sta:ements are We, cortect, and wmple;e.
(m�mDe� er�0 shre4 �Y. �e:e, arHLPmcp)
s. lc��v � RP�a
acre immeEWtey
ONar lane
Tobl lantl (lina 1 p/us lina 1)
Resitl¢ntial improvemanb or
Annualty Assessed Mobil¢ /
Manutacturetl Home
o.�nioB
Gaage
Oiher Improvemen6
Todl impmvemenb (lin¢ e thmugh line 6;
7opl value (line7 pl�s line l)
I h¢reby ceNty �he aCava is we, correcq
antl camplete.
Im.yig aCim - Sqna �•re o�aie�:w
(7)
a)
(3)
(4)
(5)
(6)
of Assezwr
20 �y 20 _ Lesserof 60% of Ne assessed vJve ct Ne homes:ead or 545,000
NafwiNSfarMing any otherprovison, fhe wm ol (he tled�mtiwis poviCetl in IC 61. f-f 2 ro a rtrobile home 5
Nal is not assessed as reel pmperty w ro a manu(acfumd hwrre fhat is rrot assessetl as real pmpeM may
nof erceed one-haH(12) ollhe assessed value oi ffre rtroWe home ormanW.aduretl hwne
DISTRIBUiION: Oigiul - Cwm.yNW :or, FieSanpee Gopy -ia�ayer
�5 C�3YfIdfIl YdQJl1J 3
❑ Yes [l No
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