HomeMy WebLinkAboutHomestead_Jorden (2)FOflM HC 10 19i9
PrewiCeC By S�a;e Boam nt Ta. Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CRE�IT FOR YEAR 19 � 9
io Be Filed in Duplicate
SEE BACK FOR FILING INSTRUCTIONS
��(We) �-°'�'�-�-�- ��� d v-�'-�-- �• certify that on the 1st day of
arch, 19 7 I, (We) occupied as our principal place of residence the foilowing described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned p6� O/OI�
❑ are buying under contract
❑ have a beneficial inqte�rest� in the taxpayer
Property Description in ,�Jt-(�--a-Q� County ��� Township
Taxing District (City- T^�•�^, Township): �-Ca--��-i'-�--
Parcel Number or legal description shown on tax statement: '� 3y�.
�3 c�. �% W�%f nJ cc.J �/.� , z-o - z - i o �"
If buying on contract: Owners
o.�e,i
Contract recorded in Recorders Office - Record No. Page
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property:
�hereby certify the above statement is true, correct and complete.
/�
�•
Atlaress
�
County Township
Gry. S�aie ano Zio �e
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 improvements
Other Land
Total Land � � �
Residential Improver�ents � � Dwelling
,'��� 1 z 1979 Garage
Other Improvemenis
T� Improvements
I �,...aby certity the
Sig�uWre ol nssessor
Approved
G/�/"-`�" Total
-�
(6) plus pb�g� (8)
is true. correct. and complete.
True Cash
Value
(i) S o 0
(�S�
�—
(3) C
(4) �/ SG o
(5) � 2 3 0
�s� � c 9 0
,>> a o 0 0
�s� 9 � 9 0
��1��:�-�����rr��i�
Assessed Homestead
Valuation Valuation
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Daie
Date: �—1 � -%�