Homestead_Clark (8)CLAIM FOR HOMESTEAD PROPERTY TAX FORM
:�_` = STANDARD / SUPPLEMENTAL DEDUCTION
��Qqi1� Sa:e Fwm 5a]3 (Rf 5/ S14) HC70
�•�1 P�eS�fiENEyNeOepaNnentotLxalGOVemmentFV.a�
INSTRUCTIONS: See reverse Sitle for filing insLUtli0n5.
NOTE: Te/ephone, Soda/ Secunry, driver's license, state idenli:icauon ar�d7ede21 iden(ilicalion numbers a2 confidenGaL •^ �p( IC„('rf1
�M�ei/`�'�/6ETG�G�J iN.�L(�iil �� ��_—�MLE�ti�'thatllw�P�aamY(�
place of residence or am (are) buying ihe following escnbed real pmperty under contract for which a Homes;ead Property Tax
Deduction is hereby Gaimed on the date this applic�ation is signed, (date o!p'gnptury).�I (Yy'
UCI, 1 j� [
❑ Owrt ❑ Am (are) buying under recorded wntract. �
❑ Am (are) entitled to occupy as a tenanbstockholder of a cooperative housing corporation. /l
❑ Have a benefidal interest in Ne Vust or Ne right m oaupy Ne pmperty under the terms of a qualiTied '—�`8�
❑ Am (are) ;he shareholder, partner, or member o: the enuty that owns the property. ,.,,,�,� W
�di.d� j'�I.c.a
r �u+n�er o�(rve eg's�
�
��>n
�Q�%Ii [J"
� number o( davnanl s spouu (1a41
u'.Yaq Fee Simpk amefz fume
II�anMf CI tldvNN
� �
RemtOe(a o3ce wt�ere mnVatl ia remrE M RacoN nivnEa Page
cwuuy ro,rsrno • rapev3 c� ch.ary� rox�n. tm.,un�p) '
/ w �i�(�
Paal numEer legal desaip4on �-1 I Is Na ptoperty in Ques'von:
�y��Q�� ❑RealWOGeM ❑Amw%assessMmoEielwme
�a
It ury pcf,ion o1 tM resiEe�Gial FY�x,ture w tle laed ml e�ceM'tg me (t) ave NI -w:iNiY.eFy sueeouMS Wt s•.iuCUre is uSeC ro pmEUre 4m:ie. tlesm0e L'a use an
� z6ry��iz�-ob - yoa - oo�f.3�s - 01. 8
tla"unant Ydn;i�g
❑ Yes I] No
I hereby certify the above siatements are we, mrtect, and comple;e. �C I �/ .��` !�y '' -
� r� c zc.�+,�
iCartu M mnaa (numDer eM 5ree1, t'iry, 5afe, enC LPmOe) A�Cress ol vata:eElwmes;ea0, �
LanE not excceding one (1) acre immediat¢ly
surtoundlnp resitlentlal ImOrovemen6
Other IanE
Toial Wnd (line f plus line 2)
Rasitlantial improvemen6 or Dwellin
Annualty Assessetl MoElle I
Manu6cNretlHOma Gangs
Othar Improvemenis
Totnl improvemenb (line d fhrough linc �
Tatal value (line J pl1s line l)
1 hereby c¢rtiy Ne abovo is we, correc4
anE tomplete.
!m()i�g ac�bn - Sg�u:ure ctNA��:w
�
�
�
(5)
i�)
20 _ pay 20 _ Lesserof 60% of Ne assessed rdue ot Ne hanes�ead w 545,000
No(niNSfaMing any oNerprovivon, Ne wm o( Ne tletlucfians provideC in IC G7. f-12 ro a rtrobde home 5
Naf is lrof assesmd as real pmperly w ro a manu(acfured hane Naf is not assessed as real propeM may
rwt exteed one-haH(f2) ol (he assessed value ol (he rtaW7e home w manWarlumd home.
DYa s9rea (rtm:n.OaY.YSe�
d5TRI8UilON: Qgial-LaueY.yAW::a,FleSampeOCOpy-Taqayer
tl
Y�'
)
H
�
Y�
�5�