HomeMy WebLinkAboutHomestead_Engler (4)FOPM HC 10 /979
ReuriCeO By SWte BoarO of Taa Commissioners
To & Filed in DuDlicare
CLAIM FOR HOMESTEAO PHOPERTY TAX CflEDIT FOR YEAR 19�
SEE BACK FOR FILING INSTRUCTIONS
�(We) � certify tFiat on the 1st day of
arch, 19��1, I, (We) occupied as o principal pla of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) Q'owned D �( /_ � DD�� n
❑ are buying under contract �� �D ��
� have a beneficial intere�s-t/ in� th�e taxpayer � /�
Property Description in Xk-(tC-e�--- County `��a+ Township .
Taxing District (City, Town, Township): ��.-ta:'� �
Parcei Number or legal description shown on tax statement:
C�-�.�Jr�.:.. U,�Ll�tnx, �n� 9 .. 7s i4
If buying on contract: Owners name �'� "'"p1e °"ne'�
Contract recorded in Recorders Office. - Record
If a�y portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe ihe use and portion of the property utilized to produce income
An other counties in which individual owns or is bu in real ro ert Count Townshi �'
Y Y 9 P P Y� Y P
,-.
certify the above statement is true, correct and complete.
AOCress
enE Zip CoCe
Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding residential i�v�eaj, � �
Other Land , L
Total Land
Residential Improvements ,IU�I 12 i979 Dwelling
/%���uJ2d�rage
�t� tal
AUDITOR
Other Improvements
To'°' Improvements - Line (6) plus (7) equals (8) `
I���y certify the above is true. correct. and complete.
5ignamre ol
Approved
True Cash
Value
(1) ..�000
(2) —
c3� 3� o0
(4) �/(oF6
(5) �
(s) a/G, �o
(�) —
(8) �/(o �o
- ACTION BY AUDITOR -
Assessed
Valuation
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Date:
Homestead
Valuation
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