HomeMy WebLinkAboutHomestead_RawlinsonCLAIM FOR HOMESTEAD PROPERTY TAX
: e_n� _, STANDARD I SUPPIEMENTAL DEDUCTION FORM v
S:a:eFOrtnSa]3(R15/Sfq � HC�� p
���' Prezmbetl M Ure DeGartment o: loral Gwemr.+etrt Fvunre q
INSTRUCTIONS: See reverse vtle (or filiig inshvc(:ons.
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MOTB Telephone, Soria/ Secunry, tlrivers license, sfae idenu;xation aM fetle2l itlenli�ica(ion numbers are wn;itlenlial ander IC G1. f-12-3;
I(We) � P. �. X . V[�+�n_�_ l e�' _�..� ��,�� i iwe) occupied as my (our) pt
place of residence or am (are) buying Ne follo g descnbed real property under contract for which a Homes;ead Pw Ta: St
Deduction is hereby Gaimed on ihe da:e this applica;ion is signed, (date o/signaf
�. O Fvn (are) buying under recorded conVact. GIBSON COU�
Am (are) entitletl to occupy as a tenanFStockholder of a cooperetive housing corporation.
❑ Have a benefcial interest in [he trust or Ne right to occupy the pmperty under the terms of a qualified personal residence
❑ Am (are) ihe shareholder, partner, or member of the entity Ihat owns the property.
sotla� Seau�r wnce. o� min,am (�uN R.e 4"v:
Sodal semiry numeer ot Wvnant's spouu (la:
If Gryvg m mnyact, Fro 5'vnqe wmefc name
Remrdeh a5rn x.here mn7aa is recoeOM
L- ll-l'1-yD�-Zt
:Y W�t+on of Ne restlekial sSV�we w Te WM
�e F�RrY tId¢e0 ro M�uce inrome.
oftlavnaM(bYfrveas)� � �
12Irt1d11��9 5�1'A�SE (189:�NB �QSf
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ReaW w.-EC � Pape
I""°a°ce"v"c°oz:��.- �1
� 1 �}�!5 1 Real poG��i'v ❑ PmuaYY assesseC mo�ie Mme
Lo L�°
one (t) aae l'u� v:unNia'xN sunwmCe tlut ZvGU�e b usea m pvpuce vm^�e. oeun'Ee L'c ue m
I hereby certify the above siatemenis are vue, correct, antl complete.
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Otherlantl
Total IanE (line 1 plus line I)
ResitlenWl improvamen6 or
Annwity AuessaA Mobile I
Manuhcturetl Homa
Dwelling
Garege
Other improvemenb
Tobl improvements (lin¢ d through /ine �
ToGI value (line 3 pAs line �
I hereby certify tha abova is Vue, correct,
and complete.
�a.y'vg aaion - Sig`u:ure W aid�tor
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(5)
(fi)
n)
(8)
m daimam
20 _ pay 20 _ Lesser af 60% of Ne assesse0 vrlue of the twmes:eatl or Sn5,000
Nohnthstariding any oNerpravivon, Ihe sum o7 Ne tletluct'ons provided in /C S f.1-12 (o a rtwbile frome 5
Nal is raf assessetl as real p�operty w ro a menufaUUmd hortre Naf is rro( essessetl as ieelproperty may
nof ezceetl one-hatl (iQ) of the assessed vabe d Ne moWe home wmanufaGUred home.
asrwaunoH: are;w- co�,:ra,a::ar. �esamo� coor-T�r>
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