Homestead_Wheeler (5)CLAIM FOR HOMESTEAD PROPERTY TAX FORM
-4_r_-� � : STANDARD I SUPPLEMENTAL DEDUCTION
Sta:e Foim Sa)3 (R15 / &1a) HC70
��' PrestnOedCYNeOaWf.mlr.:dLOralGv+e�rvreniFVUrce
INSTRUCTIONS: See reverse sitle lar filirg inslruIXUns.
NOTE: Te/epfrone, Social Secunry, tllivers license, sfate itlenlificaWn and lederal identificafion numbers are aon:denu�r•..�:�a�•lf�-i.�
1 (VJe) certify that I (wpjlocw{1id� (ddr}¢rik
place of residence or am (are) buying the foll "ng descri real.pmperty under contract for which a Homestead Property Taz San
�eduCion is hereby daimed on Ne da:e Ws applicatlon is signed, (date oliSjCyafun)nl (rieMS
1`IUY lO�LUI
❑ Own. ❑ Am (are) buying under recortled contract.
❑ Am (are) en[itled ro occupy as a tenant-stockholder of a cooperative housing wrporation. /�` � � �.
❑ Have a benefiUal in;erest in the Wst or ihe right to ocwpy the pmperty under the tertns of a quaGfied ppQ{p{y�l,ch/¢�µr
❑ Am (are) the shareholder, partner, or mem6er of the enti that owns the ro ert . �`�����`"��D��'�d�
h P P Y �.,,�. .� nnuurv ni
.=
Pa2elnumEn ' Legaldesmp:an 7 .75 /}S IsNepvp�linQUesSOn: �
/.•• ✓E �C /•3 ^ I ^ ❑ Real MoRry Trnwry assesseC moEie lan
w
u a^Y P� m ine �eside�Cial struaure m tne IaM mt e��eCV+9 me (t) aee Yat'. -ieeu:eh uurwMS wt r.tunure u useE m WvCU¢'umie.0esrnee ine uae
of P.e VoxrY vdaea to o�ure'vimme.
a�- ►7- � 9-�{oo - o o�f• 3 � S-o �
I hereby certify Ne above sta;ements are true, cortect, and
Otl�er Und
Todl land (line 1 plus lin¢ 2)
ReslCential Improvemants or
Annualy Assessetl Mabile I
ManuhctureE Home
Dweliinp
Wa9e
Oiher Improvemen6
Todl improvemen6 (tlne 4 fhmugh lino 6j
Total value (line 3 pl�s lin¢ ])
1 here0y reriiy tha above is We, corrtt4
antl complate.
ledy'ug actm - Sig�ulre of NMitor
20_pay20_
AbMiNSarMUy any other
Naf is rrot essessed as res
rroterceeEOne-haHl121[
(3)
(4)
(5)
(6)
�e�
Lesur ct 60% of Ne assessed vaue o: :he twm=s;eatl or 5�5,000
Nvm, Ne wm ol Ne tletlurlroris provide0 in IC 6 f. f-12 fo a mobile home 5
operty w!o a menu:aUUreE home Naf is na assessed as real properry may
OISiRIBUiION: Otqinal-COUirtyAUC:.o�.FieSartyedCOpy-Tay Yer
tlaimant vaca5ng a
� Yes Q No
mr.
Da:e v9� (rtm:R daY.
W:e s+9neC (rsmN. daY.
R
���
�
9