Homestead_Peterson (2):��' CLAIM FOR HOMESTEAD PROPERTY TAX
� STANDARD / SUPPLEMENTAL DEDUCTION
Sa:e Fam SaP3 (Ri5 / S14)
��'' PresaiOeC by Ne Department of Local Gove`mienl Fnance
INSTRUCTIONS: See reverse vtle (w fJing insfnxfibns
NOTE: Telephone, �Seyial Sewnty, tlrivel�yense, sate wknGScauon arM7eden
F 1R
H 1
enlialvnderlCo-p)[}p�371'0 �0��
I(We) W V �1- fLfy that I(we) ocwpied y(aur
place of residence � am (are) buying Ne follovrinq desaibed real pmperty under conVact for which a Homes:eatl
DeducGon is hereb laimed on the date this applicauon is signed, (d�g�¢�(��J�j:
� Own. ❑ Am (are) buying uMer recorded contract.
❑ Am (are) entitled to occupy as a tenant-stockholder oF a cooperative housing corporation.
❑ Have a benefdal interest in the Wst or the right ro occupy the property under Ne terms of a qualified personal residence
❑ Am (are) Ne shareholder, paNSer, or member of the en6ry that owns the property.
o5ce
name
��6-0�1 bl R?C�a.�c�-o%7
H am' ow'.+m of vc ressxrcial s7w�ae a tne larn mt c:aceine ore (1) zae mat -m-�ecirsy
d Lc P'oPMY v.d¢ea m D�uce'urcome.
I hereby certify the above statements are Vue, cortect, and complete.
WE:ess ol mrcaa (mirtNer eM 5raet r1y, 5a:e, erk L�P cMe)
fQ� t�7 /Y �. �i � . //.4i77r��d �%%E'!
Land not axceetling ona (7) acre
surtoundlny residentlal improve
ONer land
Todl land (line f plus line 2)
ResitlenWl7mprovaman6 or
Annually Ass¢ssed MoEile I
Manufacturetl Home
Other impmvemenb
Todl improvemenb (line 4 throu
Dv.e1Mg
Ganga
line
�
�
�
�
�
Signature
�
numCn
�����o��
�aea�aoa� ❑ ,
u,a, �,cure s usea m oemu�
Is tlaimant van5� a
� Yes � No
Tobl value (line 7 plis line ]) (8)
I hereby c¢rtify Na above is we, mrrec[, 54^as+re aAssassor
antl complete.
��=rnre �- sre�wre o�w,e�m, G I B SO
20 _ pay 20 _ Lesser ot fi0% ot Ne assessed vaue of tt�e homestead or 545,000
Ab�+ithsfarMvg y otherproNSioq Ne sum of the detlucfiw+s povided in IC 61./-12 fo a mobife hwne 5
lhat ls nof asse real pmperry w ro anufacmred af is rrof asmssetl as real pmperry may
rrof exceed on a7 2) oi lhe assessetl lue of fhe mobti e wmanu(aGumd hwne.
�� „�i_ ��� _ . _
wsTweunoH: arewi-couMrad.:«.�e-samoeacom-iawr�
Page
J�e use attl
dy.5at.
S "�