Homestead_Shanks.��CLAIM FOR HOMESTEAD PROPERTY TAX
� STANDARD I SUPPLEMENTAL DEDUCTION FORM
Sa:e Fam Se13 (R151 S1<) HC70
�J' PreunDaC EY �e OeW�ent af Lxal Govertur.ent Finaxe �
INSTftUCTlONS: See reverse side lor fitirg insWClions. �y �{ ��
MOTE: Tekphone, Sotlal Securiry, Eliver's Lcense, 5.ate idenlifipubn aM (etle21 itlenlificatvn num0ers arqcpi:id�;iaS4Mer Ia7G]. f-
I(VJe) certify Nat I(we) occupied as my (our) pr
place of resi ence or a(are) buying the following described real property under wnVact for whicbi�pmRsjqad�P{p�erty Tax Sc
Deduction is hereby daimed on ihe da;e Nis apPlication is signed, ���� Cdal4 bl �§,i�lde). 1(VJe):
❑ Own. ❑ Am (are) buying under recorded contraa.
❑ Am (are) entitled to occupy as a renan4stockholder of a cooperative housing corporaUo
❑ Have a benefdal interest in the wst or Ne right to ocwpy the pmperty under the��¢n� Q N OUN Y AUDITOR
❑ Am (are) the shareholder, partner, or member of the entity that owns the proper�� � V
F.:i1F'!�T�
�
iume
oSx �M�erc mn:raa is eecarEeE
WE(1'JdISyYGtllrt w
�O RWYfG IMMIC.
ddlllidfi �/d3f (NB C4;
I hereby cer[ify the above statements are true, cortect, and complete.
rreet, my, sa:e,
acre
ane� woe
Toml Wntl (line 1 plus line 2)
ResitlanUal improvemen[s or
Annualty Assessed Mobile /
Manuhctured Home
g,.»,e�� f�)
Iz)
(3)
Dnellin9 (4)
GanBe (5)
Other improvements
Total Improvemenb (line 6 thmugh line 6�
Total value (lin¢ Jpl�s line 7)
I hereby certi(y the above Is We, corteci,
(7)
(8)
Syfut re a(/�sasu
�
numeer � Paga
Ne prope .ry in Qves'.ion
�teal pioperty ❑ AmwH �� moeae nm
ol
20 _ pay 20 _ Lesser ot 60% a! tt�e assesseC veue of Ihe homeslead or 545,000
AbnriNsanding any ofherproNSion, the sum o! the detluct'nns providetl in IC 6-f. f-f 2 ro a rtwbile
lhaf i5 nof assessetl as 2al prOperry w fo e manufactmetl home Naf is nol a55esseC as real prOpc
not excAtl me-hallliRl ollhe assessetl value of lhe mob7e home w manulacfuretl home.
DISTWBUIION: OnB� - Cwnry PLE�.:w. FieSampeO Copy -iaapnyer
tla'unant vara5ng a
❑ Yes ❑ No
NOV 16 2015 �
�N COUNTY AUDITOR,
o,��//—��—! S
�,,P
5�