Homestead_Wood (14)ti
�^� CLAIM FOR HOMESTEAD PROPERTY TAX yEqR
:`�� STANDARD / SUPPLEMENTAL DEDUCTION HC10 �
Sta:e Fwm 50]3 (Rf 5/ S14)
�'' P�esrnbvpytnepepaNner.:ofLOralGOVemme.�:F :ca TT
INS7RUCTIONS: See raverse side for filing insuuclions. �■ ry �. ��
NOTE: TelepMne, Soda/ Secunty, driver's Fcense, sta:e itlenlifica;�bn arH letle2l itlenlificalion numEers are con.5tlenlial urMer IC 6f f 2-37A tl
I(We) � 60 Cl� u- cerlify that I(we) occupied as mY� pnn�� I
place of resid am (are) buying the following tlesuibed r mperty under wnVact for which a Homestead Properyie�tai(/r� 15
Deduction is hereby daimed on the date this apptication is signed, (Date o(siynature). I(We): �
�O.m. ❑ Am (are) buying under recorded con'vaa. •
� Am (are) entitled to occupy as a tenan;-stockholder of a cooperetive housing corporatiort (��B$(�A1
❑ Have a beneficial interest in Ne wst or Ne right to occupy Me property under ihe terms of a qualified person�i t05.reSddOMTsy q �
❑ Am (are) the shareholder, partner, or member of the entiry that ovms the property. �
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I hereby certify ihe above statemenLS are we, cortea, and wmplete.
l�aress N w�fay (numDereM #raet. pty.5eta. arM ZIPCOOe)
/.��'i�nl ��� F �fi�v�Lm,.�z..�
Land not exceeding ane (i) acre Immediately
surtountling rasitlentlal improvamenb
Oth¢rland
Todl land Qine 1 plus lin¢ 2)
ResitlenUal improvemanb or Dwelling
Annualty Assess¢d Mobila I
ManufacWretlHOme Gange
Other impmvem¢nb
line
Total value (line 3 plis line ])
i hereby certiFj lhe above is Wa, corrac4
(1)
(2)
(3)
I<)
(5)
(8)
Sgra:urt ctAxussor
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�aceM � 4ue
fEeai prope .ry
.?
❑ n,v�u,h �.�a �mx nome ln
) V�u¢'uca:K. eesaihe Cie:�e ero
20 _ pay 20 _ Lesserof 60% of Ne assessM rdue of Ne homestead or 545,000
NoMifhslanding any o:herprovision. Ne wm ol Ne tletlucCOns provitled in IC 6-i.142 fo a moDile home 5
:haf is not assessed es real propeRy w!o a manu:aUureE Mrrre Naf is rrof assessetl as real property may
nof erceetl one-ha7 (7/t) ol (he asses5ed value o(1he rtrodle hame wmanWacfured home.
$Iqtli:�!!E � NY�),IX
dSTRIBUiION: Ugiu1- GounryAW'sr, FIeS`ampe0 Copy -iaapayer
Is daimant rara�ng a
❑ Yes � No
(rtn't1i.GaY.Y�I
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