Homestead_Benkert (2):��° CLAIM FOR HOMESTEAD PROPERTY TAX FORM Y�R
STANDARD I SUPPLEMENTAL DEDUCTION .
Sta:e Farm 5,93 (R15 / Sfa) HC70
�% PresoiOeJ py iM pepartment d lual Govemmem Frana '
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INSTRUCTIONS: See reverse side /a fslg instructons. J�, `
A'OTE: Telephme, Sadal Secvnry, E�ive/s license, 5fa:e itlanU,`rta0on aritl fetle2l;denli;K.auan rtumbers are oonfiCentlal uMer IC Gf. ]-f 2-37. , p
I (We) 7 - � � _ � - cerii y�Uiat I (we) ocwpi��
place of residence or am (are) buying the foll � descn real pmperty under conVaa for which a Homestead
DeducGon isAereby ;med on Ne da:e ihis applin5on is signed, (da:e of signa�
�Own. . '� ❑ Am (are) buying under recordetl contract.
❑ Am (are) entitled ro occupy as a tenant-stockholder of a cooperative housing wrporation.
❑ Have a beneficial interest in ihe Vust or ihe right to occupy ihe property under ihe tertns of a quali;ied personal
❑ Am (are) the shareholder, partner, or member of the entiry ihat owns the pmperty.
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Recwtlefs o5ce wMre
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a^Y G�m M Ne resqeT.u� struRUre w Uw Wm not eaaeainB one (t7 aae
ne prope .ry vTaea w proaum vKOme.
�Y �V/��//'!/IVQ iOQ�. o`� �
t hereby certify Ne above siatements are Vue, cortecl, and comple:e.
v�e
OlharlanE
Todl land (line 1 plus line I)
Resitlentlal improvemanb or
Annwity AssesseA MoGlle /
Manufacturetl Home
an..�,:,. �LP�� yir�3 y
Dweliing
Ganpe
ONer improvemenb
Todl improvements pine 0 Nmugh line 67
Tobl value (line ]pl�s line ])
1 hereby ceriiy the above is We, con¢ct,
and compi¢te.
leSy'vg aGion - Sg�ulre o� PuEito�
711
(5)
(6)
(7)
(B)
Retvttl num0et
, �. ,.
roveny � a�e:•.;w. V
aea� v�vem ❑ nmwN assessee no�ie nome (rc it.1-n
31 Y.IVCUre is useE b pfO�ucY YN9.:1¢, Ot5C10G LY VSE dttl pJfli0tl
20 _ pay 20 _ Lesser of 60% ot Ne assessed vrlue of the homes;eatl or Sa5,000
Noh.i;hsfanCing any otherpmvisioq (he wm a! Me tleduc(ions proviCeC in IC 64.142 to a mobile frome 5
Ma1 is rro( essessetl as raal property orlo a manu7acfured hortre Naf is rrot essessed as real property may
rmf ercaetl one-haH (12) ollhe essessetl value o/ t�e moW7e hane w manulaCUreE hwne.
OISTRIBUTiON: Uiqiui-GOUnryAWrtw.Fdo-SUmpeEGapy-Tamayer
Is daimant vacatl`g a homes:eatl?
❑Yes �No
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Das v5:x0 (nMt, CaY.Yeail
Da:e si9 W lrsm:n. CaY.l°a�)
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