Homestead_SuttonPrescn�eo By 9ate Boam ol Ta+ Cornissioneis
CLAIM FOR HOMESTEAD PROPERTY TAX CREOIT fOR YEAR 19-22
INSTRUCTION
�� (We)�Cri^�-��- L'�-' �--�"�r� y�� '�-'� certify that on the 1st day of
Aarch, 19?1"�, I, (We) occupied as our principal place of residence the following described real property for
which a Homesiead Property Tax Credit is hereby being claimed:
I, (We) C3"owned �b�-D�/3��
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in � County ��� Tawnship
Taxing District (City, Town, Township): ��� �.�L
Parcel Number or legal description shown on tax statement:
P� . N E�/� 7- �. // e?. Sz� .9.
If buying-on contract: Owners
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:
i hereb certify the above statement is true, correct and complete.
�. /i; _. _.. /i /ld _ /�.�3 /,��
cadress
County Township
Ciry. Stare ana Zio Cxe
�"' lndivi ua� ither owns or is buying under a contract that provides he is to pay the properiy taxes
on the residence, or has a beneficial interest in ihe taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding t(one) acre immediately
surrounding reside i r m
Other Land � � � �
Total Land
Residential Improvementsi••�'_ � ��79
� �', / ^
�� AUDITQR
Other Improvements
Dwelling
Garage
Total
7�t�1 Improvements - Line (6) plus (7) equals (8)
�:by ceriify the above is true. correct. and complete.
Asseswr
Ap
�
True Cash
Value
(�) .ipo
(2) 7b�
(3) �� �
(4) yic
(5) —
ts� 9ia
(i)
(8) %/�
- ACTION BY AUDITOR -
Assessed
Valuation
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Homestead
Valuation
Date: ,��-����