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Homestead_Fallsz/-r• CLAIM FOR HOMESTEAD PROPERTY TAX FORm YEAR
:��'�; STANDARD I SUPPLEMENTAL DEOUCTION
��t�• 5u:e Fwm 5+�3 (At5/&�a� HC10
' PrescnCeE�yttrepeparime'voiLOralGC�:errr..e�Fr.::.re
LVSTRUCTI0.VS: See reverse vtle for �lrrg inshuclions. ��� ��
NOTE T¢lephone, Social Secunty, drive/5 Gcense, state idenUfical:on arM fetleal itlenG:¢ation numbcrs ara en I u. er IC 12-
I(We) (�C�UiLt ��. ¢!�n.dC.2CP. [�, � � ��certify that I(we) ocwpied as my (our) pnndpal
place of resitlence or am (are) buying the follovnng descnbed real prope ,ry under contract for which�(� e��Q�j7�Y Tax Standard
Deduction is hereby Uaimed on the date this appliwtion is signed, "Tth^e H/S!grfa!5!e�. I(VJe):
❑ Oan. ❑ Am (are) buying under recorded conVact.
❑ Am (are) en:itled to occupy as a tenanbstockholder of a cooperative housing corporation.
❑ Have a bene5cial interest in the trust or the right ro occupy ihe property under ihe t��Sc` �' ' '��ITORNSt.
❑ Am (are) the shareholder, partner, or member of the entl,y that owns the property.
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rown,
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`�y � � ���_
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Parrel numEx L al aeunp:pn Is iM pro�Fny in pues0on.
�(/ _, I Q�I.{/� [ ❑ Real yopertY Pmue?/ assesud mob2e twr.ie (IC 61.1-n
/( 4R�C..
If a�"�IXIICI101 L�E IMI(1G11'Jd15.fllqut¢ Of �IM lin0 (10f ¢aCQEjCYj. OM (1) aGP L`.a: YN:I¢Eia:e�y SYROYf105 Nd� SWqUR i5 USlC 10 [(OOIIR 11�9.^.le, E[SOIb[ :'1P LS¢ d�C MfJ011
O: N[ W�G�Y 1f.I¢M (O W WYR IIIGMIE.
a�- ��-oa -yoo - 00�{99�,0��
Sa�, Coury, aM Ta+uNp
Sgraure qi +r nt
I hereby certify the above sa;emen's are true, wner,, arM co.r,ple;z. � �i�
_�� �
,va:essMCVraelnumav/amsbeel.mY.staf/e.e��aLawde) nmresswvao;eatiames�.eaa
%�% /"Y74ftL l�i✓� �'fil C[[ ' �.J �% S
Lantl not exccetling ona (1) acra immediatety ���� . �
ONer lantl
Toql lantl (line f plus llne 1)
Resitlential Improvements or
Annually Assessatl Mabile /
Manufactured Nome
Dwelling
Garage
Todi improvements pine d Ihrough line 6
Total value (lina ] plis Ilne 7�
I hereby cartify Ne above is true, rortecq
and complete.
Vatrryg aem - 59NUe ol PW:.or
(B)
20 _ pay 20 _ Lesserot 6096 0: Ne assessed vave ot :he homes'saC ot SG5,000
AblmNSfarMirg any ofharpmvison, Ihe wm af �he deduc:bns pvvdetl in IC G 1.1-1210 a mo�ile home 5
Naf is nof as5e55eE as real property w(o a manv:adured l+ome that a nof assessed as real property may
rwt erceeE or�haV (iR) ollha assessed vabe olfhe moW7e hon, e w manu:aflured hwne.
�ISTRIBUTION: O�ynal - Coumy AuE.(w, F�eStampN Capy -
Is tlaLmanlvaa'sg a Mnes:ead?
� Yes 0 No
Da•s i9nM
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