HomeMy WebLinkAboutHomestead_Hardiman (15)"rGnt.1 C t0 15i9 lo Uc hl�b i Ouv6cete
?resc�i�M 9y Sate Boa�C ol la. Commrssionz�s '
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 191.1�
SE ACK FO ILING INSTRUCTIONS
;��) � ' certify that on the tst day o(
tNa,�h, 19 , I, (We) occupied as our principal place of residence the following described real properiy for
�vhich a Homesiead Property Tax Credit is hereby being claimed:
I, (We) �vned
❑ are buying under con%�� t
❑ have a beneficial intdCes/. in�
oo� oo i9i o o�'
Property Description in '�.�/�/ W�' Co nt � Township
Taxing District (City, Town, Township):�, �_/� �lf"7�L– '
Parcel Number or I I descripiion shown on tax statement:
c�� o-� .� 11 ^/—/ a l,1�3� .
�i buying Ofl contract Owners name ��ee slmpie ownerl .
Contract recorded in Recorders Office - Record No. Page
Ii any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
siructure is used to produce income, describe the�use and portion oi the property utilized to produce income
Any other counties in evhich individual owns or is buying real properiy: County Township
I�by certify the above statement is true, correct and complete.
�� .. �,� c,..�. �.�.� `� fS cr�t. 2 a7 ��.,,,.� �',a^t�rn _ `�' 7 6
('S�gnamre Svee. Tacress - � Gty. State an0 Zi0 Goae
' 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.
�c"-��q ��t1,�
���_�
- FOR ASSESSOR'S USE ONLY
����`! 2 �' iguo
Land not exceeding 7(one) acre immediately
surrounding–°tesid�e�n,ti� improvements
Other Land ��D/TOf; L�"��'
Total Land
Residential Impro��ements
True Cash
Value
(�)
(z)
(3)
D�velling (4)
Garage �5�
Total �6�
Other improvements
� Tot2��t�ements - Line (6) plus (7) equals (8)
1 hereoy certify the above is true. correct. and complete.
S�pna:me ot :o:esw�
appiGV2d
(�)
(8)
Assessed
Valuation
�:,:.
Homesiead
Valuation
Dale: `� "� / � I —
�
�