HomeMy WebLinkAboutHomestead_Smith (15)z��c�'�F; CLAIM FOR HOMESTEAD PROPERTY TAX
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INSTRUCTIONS: See reverse sitle Im filing inshuctians.
NOTE: 7efephone, Social Secunty, tlrrve/s licenu, sia.e w'enti;:cation and lederal itlen(ifiwtion numbers are
FORM YEAR
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I (VJeJ ��C�� �- ��/ a��4/�/ ��yti. � �¢rti�y.wat I �)��,.-���liy�7.ry�nnopal
place of residence or am (are) buying ;he tollowing described real property under contract for which a Homestead Pmpe ,ry Tax Standard
Deduction is hereby Gaimed on Ihe da:z this applica5on is signzd, �d�ep( �j9�y,�j I(VJe):
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❑ Own. ❑ Am (are) buying under recorded contract.
❑ Am (are) en:i;led to occupy as a tenant-srockholder of a cooperative housing corporation. /�
❑ Have a beneficial interest in the tmst or ihe right ;o occupy [he prope ,ry under the terms of ap" Q�Ij,��e i ence trust.
❑ Am (are) the shareholder, partner, or member of the en;i,y that owns the property.,,,,,,, hlalv/�t
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Pd:LPI(1YI�bN LE9dIJPWIp011 yn � IIS(IIPpfOF¢RyY1Cl1¢5Wf1;
/- 1� //i �. I� ❑ Real propef.y ❑ AmuaCy assessH mobie home (IC 61.1-�
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it any po.JOn ot �e :estlen:ial s:ruC.ure or Ne Ia�W ewt erreeCim or�e (:) acre L�at' . me�ia;ely wrtouMS Na: s'.t�GUre is use0 to yoEUtx'urvr.ne, Oesuibe L'ie use arv] pof n
cf tie proce�^f v.�� m produce inmme.
a�.23 -1�- aoo- aoa. Y�4-oa�
Co�nY. a:x� Twnstvp
I hereby certiy Ne above statements are ;rue, conect, and comple;e. Y
.eGeuotwrac(numberantlstree�,c.rys:/at,aru'ZI➢wde) \
ibsa ���, p�i.n,h l�..lti.H�nst�.l�7r,�i�c�'.�
ONer lantl
Todl lantl (line 1 p/us line i)
Residential improvemen6 or
Annually AssesseC Mobile /
Manufactlired Home
Owelling
Garage
Other impmvements
Total impmvemenK (line 4[hmvgh line 6�
ToGI value (line 3 plis line n
I hereby certi(y ihe above is Uue, correcq
and complete.
.ai:ryg aCion - SiynaMe oilwEi:cr
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(4)
(5)
(6)
P)
(8)
55ra:ure c: ASUSSa
20 _ pay 20 lesse: of 69% o( Ne assessed v�ue c;he homest=ad or Sa5,000
NoMithstarMGmanyotherpmvissoqfhesumo/theCeduc(ionspro»CetlinIGG1.1-f2toamobifehome S
Nat is nof assess4 as 2al pmperty or ro a man Wacfured hwne lhal is not assessed as real pmperty may
rwt exceetl on�haC (]rJ o1(he assessed va/ue o7fhe mobti_ home ormanu:actured home.
DISTRIBUiION: Ongval-COVr..yFU6:w, Re�SanµU Copy- iazpayer
Is da'ur:an: varatleg a homes:eatl7
❑ Yes � No
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Da:e si5ned (man:.h. caY. Yea�)
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