Homestead_Parker (5)'4 CLAIM FOR HOMESTEAD PROPERTY TAX FORM
:,—f -i � STANDARD / SUPPLEMENTAL DEDUCTION
,�g�j Sas Fwm SN3 (R151 S1a) HC70
•'��3% PresmMEbytheDeparanento(LOWGOVemxmFwrcn
l��i$T(i�J(�.TIQV$: $EE BV¢ISB 5ldC /O! ilill19Y15WC1.0115.
NOTE: Tekphone, Social Secunry, driveYS ticense, Yate idenf,ficaWn arH lede2l itlenlificafion numbers are oon:+Cenlial under I .1- -3
� M'e) nify Nat I(we) ocapied as m �
place of residence or am (are) "ng ihe foilowing described real pmpe nder raa for which a Homes:eatl Pr���
DeduGion is hereby daimed on the da:e Nis applica�on is signed, (date o7signature). 1
❑ Am (are) buying under recorded contraa. �
Am (are) en:iUed to occupy as a tenan4stockholder of a cooperetive housing corporation.
� Have a beneficial interest in the wst or Ne right to ocwpY ihe pmperty under the terms of a quatif"��.(��
❑ Am (are) Ne shareholder, partner, or member of ihe entiry ihat ams Ne property.
d�o-,
iCa�H(/d4(.'.9C92i) G�RI9ER(i5G/1CGIf�:.� 'JIXI/0'.IIC!l1MICG!
� �
CaunY To.vr
P^arcNr.umber Lega
x� �I
It atry portim ot L'ie resiEertal s•.ruGUre u Ne IaM
O( t�e ryopeY.y Ud¢eC IO protluce itlCOme.
Sxs. Courcy. anC Tv.msNp
Q_
GM�1)
I hereby certify Ne above siatements are we, mrtect and complete.
d�dQressMCttf�faCn(�nu—mbere`MStree{l,�a(y,4e-te,oeM�Z�IP�yL e) ^j/I
T I V 1f4C/ 1� 1.}� �1.M1� f7GVn r L�
Land not ezceeding one (1) acre Immedia[ety
surtountling resiCantlal impr�
OtherlanE
Todl land (line 1 plus line n
Resitlantial improvamanb or
Annualty Ass¢ss¢d Moblle /
ManufdctureE Moma
Dwolllnp
Gaaga
Todl improvem¢n� (lin¢ 1 throu9h lina �
Total value (line 3 plla line ]J
I hereby certify the above Is [rue, corr¢c4
antl compl¢te.
VaJyvg atlion - Sy�u.ure of NM:lor
�
�
�
�
�
�
b
( )
manEer � Pape
Io�NlSllq)
'al prope�ty ❑ qrnuafy asusxJ rtropie Mrte (IC 61.1-1�
1
Y.NCY(! R 18lY1 b F�� WY YYMIG.OtSQICG �IX YfG dfW ��M
p CC'f tI `� � �
20 pay 20 _ Lesser of 60% of Ihe assesse0 v�ue of the homesteatl or Sa5,000
AbM+;hslarW'uig any otherprovivm, Ne wm ol Ne tletlucfions provided in /C 51.1-12 fo a mobile fwme 5
Nai is not assessed as real pmperty w(o a manulacturad Arnre Nat is irof assessatl as real pmpeM may
rrot esceed one-haH(1R) olfhe assessetl value ol Ne mobile lama ormanu:aGUred fame.
dSTRIBUTION: OegTal - Gouny fudibr. FieS`ampe0 Copy -Ta.Wyer
tlaimant ventlng
❑ Yes � No
arH s�fin1el ory. 5ab.
��D ( �
�l�J
M� �
5