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' CLAIM FOR HOMESTEAD PROPERTY TAX FORM
STANDARDISUPPLEMENTALDEDUCTION
Sax Fwm SnJ3 (R15 / Sta) HC70
•�' PresaibeE Cy Ne �epartment of Loml Go+ertur.er.t Fuunce
INSTRUCTIONS: See ieverse sitle far filirg insWCfions.
NOTE: TefepMne, Social Secunty, drivers ticensa, stafe idenlificauon arW lederal iden(itxafion num6ers are confitlen0al underlG�1. f-
1(VJe) certiry that I(we) oa:�$,ied a�my ur pr
place of residence or am (are) buying the foliovring descnbed real pmpe nder conVaq for which a Homestead Property ax S:
DeduCJon is hereby Gaimed on the da:e Nis applica5on is signed, (tla.e olsign�{ym� I�lA'e):
!!C 21
❑ Own. ❑ Am (are) buying under recorded conVact.
❑ Am (are) entitletl to occupy as a tenan4stockholder of a cooperaWe housing corporetion.
❑ Have a benefidal interest in the trust or Ne right to occupy Ne property under the tertns of a qualified pe reside
❑ Am (are) the shareholder, partner, or member of ihe enliry ihat owns the property. �,,, __
Caw�y
TvlmNUp
E5•M (cYy, lown.
Po J nv.nber I Legal Eesqiption a Q. 7��� Is �M1e property in Questv�:
5(N N G.J R- 3- 9 ❑ Reai aopeny ❑ AmuaOy assessea moWe nome (I�
tt aM Gor,ion M U�e �eskerc.ial sTMUre w iM1e Wn0 nd e�ceeCVfp me (t) ave Nal'cnmeOiYSty wrtou�ks W15.�uGUre is ufM b pmEUS'umme, EeS�nEe Ne use aM
d Cte pope.^.y N.d¢M to pfWvR vmme. ,
a�-ao-o8-/ov-ooa. os�,-oo/
Sas, CouRy, an0 TwvmNp
I hereby certify the above statemen's are we, cortect, and mmple;e.
.eeress o' mr a��wMar eN s�ea�. aY 5are_ ard LPOOM . � �. r �
land not exceedina ona 111 acre
Otherbntl
Toial WnC (line 1 plusline �
Residenual imprwamen6 or
Annualy Assasaod Mobile /
ManufacNred Home
Oweliing
Garaga
Oth¢r improvemenb
Todl improvements (line A Nrough line 6�
Todlvalu¢ pine7plisline7)
I hereby certity the abov¢ is We, correcq
and complete.
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Sg�u:iae o:ASSessor
20 _ pay 20 _ Lesser of 60% of ihe assessed value oHhe homesteaC or 545,000
Ab,-ni:hsarid'ug any ofher pmvision, Me sum oifie Ceduclions pmvitletl in IC 6f. f42 to a mobile frortre 5
Nat is lw! assessetl as real property or fo a manWacluraC lrome that is raf assessetl as 2alproperty may
rrot ezceetl ona-haH(1RJ oiNe assessetl vaNe otfhe mobde fwrrre w manufacYUretl home.
$i��, ofNS]�'N / ` /
WSiRIBUTION: Otqval � CounryAW i:or. F�eStampeE Copy - iupayer
daunan; vaca��g a
❑ Yes � No
oty YLt.
(ma�Ht �Y. Y�)
M�P
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