Homestead_Roberts (2)e
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�� CLAIM FOR HOMESTEAD PROPERTY TAX
-t _ k STANDARD / SUPPLEMENTAL DEDUCTION
S:a:e Portn Sa]] (Rt5 / &ta)
��l PresaiMC by Ne Department ct Loml Gvremrtrent Fviance
INSTRUCDONS: See reverse vtle /or Nirg insru^lions.
r FORM Y`� �
HC70 I
NOTE: Telephone, Social Secunty, tlliver's " sfate ideriL:�cauon arid lede2l idenu,5cauon numDars are con:iCentlal untler IC G1Jd2�� �C
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I(We) - �� certity that I(we) occupied as my r) pnnci I
place of re- n e '(are) buying the following described real property under contract for which a Homesteatl Pmpe
Deductio is ere imed on the da.e ffiis applica6on is signeq (date o7�.j�j� I�LNTY
❑ Am (are) buying under recorded contract. U[
�Mn (are) entilled to occupy as a tenant-s;ockholder of a cooperative housing wrporation.
I❑ Have a benefcial interest in the wst or ihe right to ocwpy the property under the terms of a qualified personal residence wst.
❑ Fvn (are) the shareholder, partner, or member of the entity that owns the property.
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Cau (/ � �^' ) Tv+.r.sNp Ta:vg dis ict ry. lo�m. ronnshy)
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Parcel numDer Legal tlesai0� I�.. U�ie�p/ropeny in ques3on
I� Peal p�opeM1y Q Amwfy ascts N noNe Mme (IC 6f.1-])
I: i:ry �fJ0.'1 G: L'R YSq¢f.'udl E'JUCUR W L`.e Ia:W Mt e!2lC�vg w's (1) a.^e L'u: -CUI�lE'Y.eFy zurza.. s W� S:NGUR is usCC �'v'�tWUS YICP^.b, CGSC.'.lE 4'�¢ VYG ittl NfAn
U me pvpe .ry v.l'¢en to qvCUCe'vicwne". /
G��-/9-0���' %/�9�0�� �
�r. �..ro r�,
� I hereby certiy :he above sta;emens are vue, corteci, and comple:e.
' � �/ / /��AA:/d�n fe�� I.uy.4ale,eMLP1 O v � ��
% .�. /
L' / C�
Lantl not ¢zcreEing one (1) acre immediatety
surtountlinp residentlal Impr
OtharlanC ,
Todl land (line 1 plus lina i)
ReslEentlal impmvements or
Annualy Assessed Mobile I
Manuhcturetl Homa
ONer Improvements
i "
Aweiling
Gange
Total improvemenis Qina d fhrough line 6;
ToGI value (line 3 pl�s line l)
I hercby certity Ne above Is 4�e, correc;
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(8)
Sig�u re c: Auessar
I Is daimant vaca5n� a homes',eatl?
� Yes �j No
m m davnaiv
� 3/ � �' Sn� �` -/Lv�u <cr
,s at vao:eC Mmes:ead, A any (nurzNar eM s'met, rSg 5ae, erM ZIP�
�. . . : . . ', h, : . �.'. ^
Da:e
t �
20_ pay 2�_ Lessero:60%o'the assessed value of ihe homestead ar 545,000
Abt��ifhsanding any olnerprovision, 1he wm a/Me tletlucGOns provitled in IC &f.1-12 ro a mobile home 5
Naf is not assessetl as real pmperry or ro a manulacluratl fmme J+af is irof assesmC as 2alprope .ry may
nof ercaetl one-hatl(lRJ ol the assessetl vaNe ol Ne moGle home w manWacYUretl home.
Sq�u.ure of /wG:x
DISTRI9UiWN: O:ig:vl-GOUntyAWitw. FicS�anpW CoQy-TaipaYer
(rnX.t GY. HM
9
ITOR
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