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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. � rown, ( �� `�y � � ���_ ��i�Y.��.:.�-� �� - '�� 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 oa:� fs�a eaY.Y^a0 D J� Mi 5