Homestead_Blythe (3) r . ..
.„. CLAIM FOR HOMESTEAD PROPERTY TAX --,
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! % STANDARD/SUPPLEMENTAL DEDUCTION FORM F:lif i:I
14 1,, Sao.t non 5473 0,2,1-20i HCIO I 2 .22--
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. n........_. 4,"' 1,,,,ndbor...,ty Wu nnpatetszlevnt or oral Governinteli Nah.,
AS TROC TIONS See If IV,Set s....1e for IA/sr airrrerriOnS
NO rE Toiephono Social Secant),Omer s license.Vale iderure'...atroa and fodora;lecrl.f,at.rr...bem are confidonool undo,IC 64,142.3?.
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.-certify that I(we)actPored as my bet principal
place of residence orar (are)buying(tie 101arg
descriterd real properly under contract fn.which a Homestead Properly Tax Srandard !
Ileductran is hereby clamed Ott ths dale this apple.e2on ir.signed , ,. ...Plate of signature) I(Serif
Am(are)buying under recorded contract.
r-.1 I(are)enbtled to occupy as a terrant0stockticIder of a cooperative housing 1-mrporatien 1
'L.-. Have a beneficial InterreSt rn the trust or the incite to occupy the property under the terms of a goat:fled personal residence trust ;
IT: Am(are)the shareho(der.partner,or member el Pm entity that owns the property
centred.Fro&loam owner's noes,
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i I.tep. elv ” ,..al s,,,,., . . r v.Cri.,stan
I1 Pont p•opatf, Li annum,orsessoo nviair nano ifC 6.f
r.1,,a carrot',tkl,,TWI tO Vad,d!et•',RIV '
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PROPERTY OWNED ELSEWHERE BY CLAMART
i Wahl Coi.aly snot Townef/a. Is r...,vacating a homestead? .....-a
Yes f 3 No 41ke - .'N
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. • I hereby Gentry Me SIPOve statements are true.correct.and Cortipleie
' i .4/1.4idittei4o- 14 (var.
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.Adisass orrar44.• ,mayer-If stn..,co;orate s,,.a Z.Pcoos valc,...el vjaaleil taor-r,Ivvi..ay.,,,,,,.,.1,1 ale...1/try sratet aea•it...ea:III
2_2_g E,- tt-iscA-N1..00
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tril WI,AUr' -Dr 4-I4"C 39
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RES/OENTIAL
VALUE
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Land not escre•eing ono(I)acre Immediately -,....,-. '„,,''.`.._," .
,eurro.P.SIMI9 feAIE.Ien.titti_trtMAYSSIERft. ...- 11' _ -- .-- -1 - — .'"... -0. siit... ..fire--' .0
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Other land (Sr '..4 irl'.A. .....r. n
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Total land Vino I plus Una 21 (3) I
• Rosidential improvements or Dwelling ;(s,
II
annually assessed rinobilo/ •- .- . i-
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.manufactured home I Garage 1(S) i • •—
Other Improvements ;fa) l''':4
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! L Treat improvements(Ono 4 through lino 6)
Total value dine 3 PA.ffne n :161 .': - . G I BS Q_N_COLINTV-A _DI 11110P-
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riognal....sa o.....e,s... i nAfff CSred wet-fir crjj,-.,T--
1 t thereby certify the above la true.Correct,
' and complete. ,
I Vorifsvo adv.:.54.0..0,13 tV".01.t.. 'ad.ores 17.4....1r,or,;saes 1
20 Day 20 Lesser of 60%of rho asSesse ,a1 d .m of th o e rinfoolor
ad or S45.000 ,
NoNogisforiding any other prevela,the sum arum ded-eChoris provard in IC 6./i.f 2 LI a rnolele Porno ! 5
i root is nor assessed as rear property or to a rnonr-facterred ri:i that is flat es504600 Cs roar PrraftrlY may 1
not exceed one-half f 1/2)of the assessor!value of Ina - , •or ItlantpfaClure4 nOrne ,
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La..- irlaee'Mgt,
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DISTMSOPION•OTV.M.. Cotary two.;r vaSiroatitilCup• -r•
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