Homestead_The IHJH Lmtd PtnspFORM HC 70 7979
PresaibeE By Siate BaarO af Tm Cammissionvs
To & FIM in Ouplica�e
CLAIM FOR HO TEAD PAOPERTY TAX CREOIT FOR YEAH 19
�,�Q, �� � �� SEE ACK FOR FILING INSTRUCTIONS
i�(We) ��, `-''�- �� �-• certify that on the 1st day of
,narch, 19� I, (We) occupied as our principal lace of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description
Taxing District (GiFy--Iewr+ Township):
Parcel Number
If buying on contract: Owners
DOIo - Db$91�
�� Township
or legal description shown on tax statement:
�-. � ��z Sc:cJ ��� /`f- z - i / ( �A� �
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.
County Tbwnship
' 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 fl[� T �
Total Land � � _. `'�'.- �
Residential Improvements 7 19� Dwelling
�UN
, arage
Other Improvements �' �
AUDITOR
To'�'-Improvements - Line (6 plus (7) equals (8)
I��y certify the above is true. correct. and complete.
Signawre ol Assesmr
True Cash
Value
�i� � o 0
(2) —
(3) � o 0
(a) a z 3 0 0
(5) '
(6) ��300
�7)
(8) a � �o c
- ACTION BY AUDITOR -
Assessed
Valuation
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Homestead
Valuation
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Date: 6 � 7- � /