Homestead_Marx (3)CLAIM FOR HOMESTEAD PROPERTY TAX �a �I�
_ STANDARD / SUPPLEMENTAL DEDUCTION
State Form Sa73 (R72 /6O9)
S / PrescriDed by Ihe D¢parMeM of Loml GovetrvneM Frerce
� INSTRUCTIONS: See reverse side for filirg insfixtions. -
c�o� JLL Ll' I
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SEP 7 2011
� � cwe� `1Y)Q.�,f�.�.u. �-� y� � ce�r wa� �e+es�e����,� ce+�wa��
place of residence or am (are) buying the following described real property for whidi a Homestead Property Tax Standard Dedudion is hereby daimed
��un,,((der conVact on ihe date this applipUon is filetl, (date oIfiling):
�( I(We) own ❑ Am (are) buying under remrded contraa
�Q Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporetion
� Have a benefiGal interest in the wst or the right to occupy the property under ihe terms of a qualifed pereonal residence wst
�.
Remrd number � Page
Wwn.
m W�tion:
Reat yopeny � qnnuapy ass�sM npp0e furtie (IC 61.7-
Ihat 6WCLrta Lv used tD poCUOB 4twrre, Eespmp N8 usa aM portion
20 _ pay 20 Lesser of 60°� ot the assessed value of the homestead or 545,000
� NoM1NMs1aM'rg any aRfh�erprouisiori, Ne sumW the deducliau prouilCd in IC fii. f-77 m e mobLe homa t/wt k $
, !10[ BSSBSSBd 85IB21 y.uyorty 0I f0 2 RHII(1�2tYLlBd h0ll1B fh8f IS lpS8S5855Bd 85 B8l PNPBn3'rt18ylpf BYL8B0
oneJieM (72) d Lre asxssed vafue dNe moblk hwne ormanularniiie0 home. '
SlgnaWROtAWItw � . .� . , Y
TowfaAip
Date signed (month. EaY. Y�+)
Date sigfred (rtmlh. tlaY. Y��
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