HomeMy WebLinkAboutHomestead_McBroomFOfIM HC lU 1979 To & FileC in Wplicate
Prescribe0 By SWte Bwrd of 7az Commissioners
CLAIM FOR HOMESTEAD PflOPEflTY TAX CREOIT FOR YEAfl 19 S2-
SEE BACK FOR FILING INSTRUCTIONS
�(We) � � ���^', �°`�'-°'�-�- �- � �°"""� �� certify that on the 1st day of
arch, 19 �1- I, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We)'�owned DQt�-Q/39�
❑ are buying under contract -
❑ have a beneficial inteJrest in the taxpayer
Property Description in �/-�-�-a� County/-� ��za-� Township
Taxing District (Gii�-�awn, Township): L`7 �'� °��`�1' •
Parcel Number or legal description shown on tax statement:
N �z �cv '% 3a- �- �o .S. �i �.
If buying on contract: Owners name �'� "'"we
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:
ereby certify the above statement is true, correct and complete.
X �����,C�� /i'�' .3 ,��=�
'S�9nawre Svret AOaress r�
County
Township
Ciry. S1ate ana 2io �aCe
t�-IG7o
' 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.
`""9�� �Qfi- $ESSOR'S USE ONLY -
f�� �
' �.�;.
True Cash
; ;r�� ; � i�:�� Value
Land not exceeding 1(one) acre immediately
surrounding residential impr�m�ts i (� ) / a S o
Other Land AUGiTOft �-4y ' (2� a i o
Total Land Q ol, (3) /�6 0
5
Residential Improvements � —(a) a o 0 0 0
Dwelling
Garage
Total
Other Improvements
T�Improvemenls - Line (6) plus (7) equals (8)
I-to�eby certify the above is true. correct. and complete.
Signacure oi nsseswr
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cg) aooco
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- ACTION BY AUDITOR -
Assessed
Valuation
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Homestead
Valuation
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Date: '�� � o - �z