Homestead_Grubb (3):�' CLAIM FOR HOMESTEAD PROPERTY TAX � � YEAFt�
= STANDARD I SUPPLEMENTAL DEDUCTION Hc�o �
Sta:e fam 5q3 (ft15 / S1<) �
�' Presa��q'��w�entolLOCalGOVemmemFwxe
INSTRUCTIONS: See rarerse sitle for fding inSWCbns.
NOTE: Te/ephone, Sotla/ Secunry, tlriveh Acense, 4afe iAenNicafbn enE (ede21 itlenGfmaUOn numbers ere confitlenfial ulMerlC 67.7-12-37.
I(We) certify that I(we) i as y(ou a
place of resitlence or am (are) b g Ne ollovring descnbeC real pmperty under contract for which a Hom � ad ro rty Ta nd�
Deduction is hereby daimed on ihe da:e this application is signed, (d f' f
❑ O.vn. ❑ Am (are) buying under recorded conVact. r� q 1
❑ Am (are) entitled to occupy as a tenanFStockhoider of a cooperaWe housing corpore:ion. DEC 1� LO15
❑ Have a benefcial in:erest in the wst or the nght to ocwpy the property under the terms of a qualified personal residence wst.
❑ Am (are) the shareholder, partner, or member of the en:iry that ams the property. �_ _ , i
ian0erofdave:an(sspouu(WYfrveCy2s) Drt+er'shenull]eT,.`v:mnl0'.tieriwmDer
ot rla�v�v's spwue Wp t,ve ayu)
3C� FQE $YfljlG W/Mi911dR1!
Paerel numCn
me P'oxM �t!¢etl to woOUrn income.
a� -i�, -is-
��
antl not ezceeC� o'e (t) aQe vat m.:ieaa:ery wrtouew vut rJu
30� _000. 7 J-/ _od-8
I hereby certi(y the above statements are we, corteci, aM comple.e.
;CErus of mn:aa (n�mtler ardY✓eat [IIY. �ro. arM LPmOe)
Land no[ ezceeding ona (7) acre Immatliately
surtountling residential improvemenb
OMar lantl
Total WnE (line 1 plus line 1)
Residentlal improvamen6 or Dweliin
Annwlty AssasseC Mobile /
ManutacNrad Home GaaBe
Other improvemenb
Tobl'unprovemenis (line < Ihrough lina 6)
Todl value (line 3 pl(s line n
1 hereby certity the above is We, cortecy
@
(5)
(7)
(8)
—
R�mtl nu.—Ac
y T ❑ nmwer usess�e moex nome Uc's�. i-n
�
s usee �� aoa�z �,mne. oesaix uro use ara voniw,
20 _ pay 20 _ Lezserot 60% of the assessetl vJue ot Ne twmes:eatl or 545,000
hbhwNSfaMing any oNerpmvivon, the wm o1 fhe tleductbns pmvitleC m IC 6 f J-f2 fo a mobile hwne 5
Nal is rrof assessed es real plopelly w ro a manufaUUmtl hwne Naf is rrot assesseE as real property may
rwf escee0 on�hatl ff2) o7 fhe assessetl value a! (he mo0de Mme w manufacluretl hwne.
SyvLreotPLEf.w , , ' \
DISTW BUiION: On9vu1- Coun•N AW i:w. F�e5lampeE Copy - Tazpayer
Is tlaiman:varaang a
❑ Yes�No
5a:e,aM
N
5 �e
V�