Homestead_Burger (3)❑
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""" CLAIM FOR HOMESTEAD �OP��a� �
_ � STANDARD/SUPPLEMENTAL DEDUCTION
'� '' StatePorm5473(R72I6-09) (] E� 3 - LUIU
�rescribed by the Department of Laal Gwemment FraiTce
� \ FORM
� HC70
YEAR ,
INSTRUCTIONS: See reverse side for filirg insWCtions. �� N� '
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��e) � certiry Nat I(we) occupied as my (our) prindpal
place of residence or am (are) buying Ue foilowi g escribed real pro for which a Homestead Property Tax Standard Deduction is hereby daimed .
untler mnUaG on �he date Ihis applintion is filed, (date oI �ling):
❑ I(We) own ❑ Am (are) buying under recorded contraa
❑ Am (are) entilled to occupy as a tenani-stockholder of a cooperalive housing corporation
� Have a benefiaal interest in the wst or the right to occupy the property under the terms ot a qualified personal residence irust
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Name ol daimant ( al nama) � �
e `
3oda� Smriry rvmber oi da'vnant (b� fie ) Drivets / IdnnVfiration / Oihu number Issui�g Sate
al tla' nt (les( (rre digrLS) .
Name of da' frt's spouse (
Sadal ewriry rnim da"manfs spouse ( Eigrts) Orive/s 6cense / ICentification /
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H Wiycig om m�bac[, Fee Simple v.meYS rame � ' .
RecorOeh ofGCe wherc tonVad is recorCeG � Remtl number Page
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Coun TownShiD . Tamg t5bi (a1y'.lown. t ip) •
Parcelnum Legaldesaiptirn I �he pertyinQUrs6on:
' Reai proprny ❑ av�uaoy assesw� mo0ue roi,re (�c G,.,-n
tt any portion of N 'dentlal sWCnue or Ne WM no1 exteeding me (1 � ame Ihat immeEiatety surtountls Nat shuGUre is usetl W poEUCe Income, desmiGe Ihe use aM portion
ot Ihe V�oPenY u tn P�uce income.
�G -�� -�S�e�Uo-oo�.��o-���
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County Township County Toxnsldp
I hereby certiy Ne above ststemenis are We, cortect arM complete. S�gnawre o( a' �
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(�ddress(iwmbe�ar�a(rae4c;N.§tefe.a!MLK/�e ZR-'/ �QM /�/ 7 / � V
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Land not exceeding 1(one) acrc Immediatety � ��1.�,�, �'.-+'.����,?�� `�,c�
sunoundin resldential im rovements. () r s�'�f Z, .3r.�,.-�,.-7��.z
ONer Wnd (2) ,'.�r�-;,�a"*-�,�,_�
Total land (line 1 plus line Z) (3) '
Dwellin9 (<) �k„����`�`•+�` ��`��`�e£�
ResldenUal ImprovemenLS or Mnualty .t*�,- ?=3�s+#.P�c : x..�o�"_a'
/luessed Mobik I Manufactured Home Gara e . '�'�=�`� a` `'�` '��:n, ..�:'�'�
9 �5� a{'�s�. 5_„! �w�.�'�.•;r:',���.:.#`�s
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Other ImProveme� (s) �«�w.�:-'�s.ix''a?:?;=".�
Total Imvrovements (llne I througn line 6j (7)
Total value (Ilne J plls Ilne 7) (B) � "
I hereby certify the above is We, conen, . Sgnature otnssessor Date signea (monm, aay, year)
and complete.
Vaifyirg acron - SignaWre M�tw Date signeE (rtronN, day, yea�
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20 _ pay 20 Lesser o160% of Ne assessed value of ihe homestead or $45.000
NoMithsfarMug anY ��rP����� Ne sum of Ne detlucL"w�s provitletl in IC Ef. f-f2 M a moblle frortre l�af is $
not esaessed as real poperty a lo e rrenulscfured hwne fhat is nof essessed as real properry mey no( erceed
orreJraH(72J d Ne assessetl rdWe W the mobde home or manula�YUred hort�e.
Slgnature of Auditnr � Date si9�ceO (month. daY. Y��)