Homestead_PegramCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Stete Fortn 5�73 (R614-03)
Prew(bed by tM Deperhnmt d Labl Grnernrtbnt Fmarxe
INSTRUCTIONS: See re`ers�a tidu br fip insburriurµ
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511
r �; `t ': '�I
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i y
a
��e) � ertiry that on ih , 20_
I(We) occupied as our p'ncipal place of resi ce ihe (ollowin9 described real pm e for which Homestead ProQG�cTac��erR d:
(iIBSVN
� I(VJe) owned ❑ Are buying under contracf
' Have a benefidal interest in the entity that is Iiable (or the property ta�ces on the property and that owns the property or is buying under a contraG.
1! huyinq on conVap, Fee Simple ownefs name
Recoidefs ofite whma contrad is retorded
!A�.��'�_�.�ti`"-:�r�'"a�4�li�a-r�-�`,.:'�._ '�•�i
Counry iamship
Parcel number
description
di5trict (cia; fawn. townShiP)
Is ihe pmperty in question:
Record numDer � Page
�%�.% � "' O I � � X � �'r {V C . 1 � � � � � — , � I �� Real DroDaM ❑ Mobile Homo (I.C. 61. f-7)
H any ponbn of Ne resiAent al sWqure or Me land not esceeding one (1) aae Ihat immeCiatety wrrounds Nat strucWre is used b protluce income. describe Ue use antl portion
o� ma woP�y �wa�a m�a� ���. .'�I 310-�.
� a�-ig-ay-yoa-c� I.alg-c��.,� �
20 (� Pay 20� �o
Lesserof 1/2 Homestead
vauaLOn or f35.000
$
SHJIIfA