Homestead_Elpers (42)H
�CLAIM FOR HOMESTEAD PROPERTY TAX y�R
�_ � STANDARD / SUPPLEMENTAL OEDUCTION / ���---777 FORM �
�.' SG:eFwm54]31R15/bta) /`��'/ HC70 �
Prest'fihNEytl:e0epanmentolLOCalGOVemmenlFVUnce �
INSTRUCTIONS:Seereversesitlelarhlinginsbucfiuris. � � �
NOTE: Tekphone, Sodal Secunty, tlrivels ticense, sta:e itlenfu5puon arM fe0erdl idanlificaLiWn numDers are con;denlial utMer IC G --3
I(VJe) � • certify that I(we) occupied as m(our) pnnppal
place of resi ence or am (are) buying the foliowing d al prope under conVact fw which a HomesteaE Pmpe���z S�ri�artlo C
Deduction is hereby daimed on the date this application is si etl, ' (date o/signaturej. I �YJe : � �
Own. � Am (are) buying under recordetl contract. .I
❑ Am (are) entiUed ro occupy as a tenanFStockholder of a cooperative housing wrporatlon.
❑ Have a beneficial interest in the wst or Me righi to occupy the property under Ne tertns of a qualified '(p�e$�/�j�J�
❑ Am (are) the shareholder, partner, or member of the entiry that owns the property. A DITOF
o5rn wnere wn'vaa is rew�tletl
�
�umcer laage
'/ � Is Ne pehy in C�s:un: (/
7�y / I Real popertY ❑��D' a5xs� modM Mme
! �
w-e cut vrcneaa:eNS�+«a+MS :nat srucure B u�M m o�uce inmrne. OesrnEe Cx iae m
ro o�uce'urane. /��`�
l�Xo- 01.�-0%/4(>. QOo2 �/�- Do2�
tlaimant van�`g a
❑ Yes ❑ No
I hereby certify the above statements are true, cortecC and complete.
.a......... o..R.....y ....o �.� a..o .......�...o.o.�
surtounLin reslEenHal im rovements (�)
Oiherland (2) I
Todl land Qine 1 plus line 1) (3) I
ResiEenUal improvamen6 or Oweliin8 (4) � � �
Annualh/ Assessed Mobila / ��
Manufactured Home Ganpa (5) I I
Other improvemants (6)
Total improvements (line d Nrough line 67 (7)
Total value (line J plis line n (8)
I hereEy certify Ihe above is We, correcl I�
anA complete.
/a�tyug aclion - SgnaWre allwtl:rot
20 _ pay 20 _ Lesser of 60% of Ue assessed value of the homesteatl or 545,000 �
I
AbMilhsfaMirg any ofierproNSion, tlie sum ol J�e detlucfions prrnidetl in IC &1. f-1210 a mobile home 5 I
fhaf is rrot assessetl as 2alproperty or fo a manulacfuretl Mme Naf is rrof asressetl as 2alpropeM may '
rrot exwe0 onahaH(12) o/fhe assessetl value o� (he moble hwne w manNaauratl nwne. ,
OISTRIBUiION: Oeipvul - County AW i;w, Fie�S`ampM Copy-Tarpayc