Homestead_Miller (7)CLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD / SUPPLEMENTAL DEDUCTION
Smte Fortn 5073 (R72 / 6-09)
t P�ibed by tha Departrtierrt o( Ldal GoremrtreM F`mnce
� INS7RUCT10NS: See rererse sida for fifmg insLudbns
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I(We) l� .f� V l/ ll� /� u /1[ __ (..{(,(/�,( � 1��.( �( Y� certify thst I(we) ompl our) prindpel
place o( residence w am (are) buying the (ollowirg descn� perty for which a Homestead Pmperry Tax Sta� rd D imed
undar mnaaa on wa da�e �n�s a��cauon �s n� ea, �dace o�m�g GIBS0�1 C�JI i�i!' �
� I(We) own ❑/4n (ara) buying under recorded coMract
�� Am are entitled to occu as e tenant-stocMiolder of e cao reWe housin co
❑ ( 1 PY Pe 9 ryoratlon
� Have a benefiGal interest in the Wst or the right to ocapy the property uMer Me tertns of a qualifled personal residence Wst
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a� w�nr LI aumm�y easeuea mome na,�e (�c o-�. �-n
ctructue Lv usetl 1n WoEUCe 4rcmre. deavme ttre use anE portlan
20 pay 20 _ Lesser of 60% oi Ne assesseC value of Ihe homestead w 545,000
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Da:e signeC (mont�. daY. YBeA
Date signeE (rtanN. OaY. Ya�