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Homestead_CoxCLAIM FOR HOMESTEAD PROPERTY TAX CREDIT/STANDARD DEDUCTION smm rmn sara (R� i sa� � P�e�bad by Ihe De�rt of Lo�l Go`ertmie�l Frw�re INSTRUCTIONS: See ieverse side /or filing ins6uctions. FORM HC70 �' A `� � M�e) �n��6.�(Q(�� ( I.CJ�I� certifY � on Ihe 1 st tl0y oP R� I(We) oaz�pied as aa prmapal pla�e oF ihe fo8owirg�d aibed real popeAy for which a Hm�esteadp�` yT1�c Credil is haeby daimed: �IMle)owr�ed ❑ Arebuymgundacontract u�.l l'1 � (QQ% . ; Have a benefidal interest m the entity that is liade fior tlie property t�ces m the popaty a�M tl�at owns Uie property ucJ;,�'^9A^� a contracL �j.:,i; 's " � :�i,`- rc Wyiig m auNar�. Fee sirr�le awrers Imme f�cortlefs office Miae corireC ia iem,ded 9 Remd num6er Eo�m. tawnddP) , Pege Parcel narms � Le9� deac�iV6m - Is iha n quegion: � dl�l8 a9-loo-cna.a�' aG-3- � � �C��, ❑�b��,.�.s,.,_n n ery portion of u,e reada� sfi„m,e u ma mne na muzednp ona (1) aue ma+:nn�da�ly anmu,m a� �u�4ae is usm ro p�oauoe :m,ie. dmabe me ��,e puUon d U�e praperly uiif�d b p`oduce eimne. �� �.��5��`_ Towns�ip I F�efCby OBfhfy H�c BbovC staEemPl1�5 81H 6i1@. COffECl2fld COff�CEB. (nlmbel e!d s6eeL �1: ��. ZIP cade) ��� � ,at ,ASSESSOR USE WlLY � . @' �?�b� E�' V/LLUE x 7 � �AT�OF�Tf1�/E : .�e�V� ,�AU�D..: � r�`r�7r:�S� _VAI-� ���`� "+„r_' v , •. . Landfrote�ngt(one)aaeirm�ediately. . ��) �.`��'�`".,#�y`�c}��'�a�'r�.�a+� SlRramdvg residen6al improvemen�. .. i r-.-.a`' '�'�v'.lr�� � K�;�6�: �18f�8fld Y �° . (Z) ! : � 3`�C'i.S : Td� IarM (I"sie 1 pkrs 6re � (g) - . � AY` 'ty��,'�f��x �.����� asi�;���i/�sz� Resdentiel "vnptoven'ients or Mrw�y ��� (4) �: �T.; . �� �"ar„'�i� ` v.''F»� ��°� � Assessed Alolxle / MarwlatGaed liort�e � :' ;r ' � � ,'.�� Yf�iJ � ��r���,',Jy, ,�, "Ec��� r� (5� 5 �lN+.�,��"'7Lr ^A:s",, 3}'r� . ,�. r.i.,.�i; �. : Other unproverr�ents (6)' �. i.Y.. �F TWaI vnpfovar� (irre I ffvour,� 6ne 6) (�) value (!ure 3 pl�s Gne n (g) I Aereby oertify the above is true. owred, and Sigr�re ot� Date ag�ed � �M^B eWon - Si�aCae dAu6mr Date signed 20_Pay20_ Lesser of 12 Hortestead V�uatian orS35,000 S -/-0 7