HomeMy WebLinkAboutHomestead_Sheltonwnrn xc io ism \
PrewriOM By State Baara ol Tae Cammissioners
To Be Filed in Ouplicate
CLAIM FOA HOMESTEAD PAOPERTY TAX CREDIT FOR YEAR 19�
SEE BACK FOR .FILING INSTRUCTIONS
�(We) �-^�`-�-Q��, `���-�1� ���/� � certify that on the 1st day of
n�arch, 19 �9 I, (We) occupied as our principal place of residenc the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contraci
❑ have a beneficial interest in the taxpayer
Property Description in
Taxing District (Gify-��am-Township):
Parcel Number
If buying on contract: Owners name �'� 5irtip1e Owne'�
Db� -b176o
�� �-"-' Township
or legal description shown on tax statement:
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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: County Township
;her by certify he ab¢ve state �e�n)t is true, correct and complete.
� �' 1TJ% IV
l/ ,� � , � �.
Signature Stteet AEEress � City. S� ta anE ZiD �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 ONIY -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
Total Land �+ �
Residential Improvements r"� � � Dw�ng
tl
JU� 27 i979Garage
• Total
Other Improvements
T� mprovements - Line (�i�s )
i�oy certify the above is tru correct. anAlllDJdQRte.
True Cash
Value
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Assessed Homestead
Valuation Valuation
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