HomeMy WebLinkAboutHomestead_Thomas (9)FOflM HC 10 7979
HescriGM By Siate BaarE a7 Taa Commissiancrs
To Be FileO in Duplicate
CLAIM FOR HOMESTEAD PAOPEHTY TAX CREDIT FOR YEAR 19 �
SEE BACK FOR FILING INSTRUCTIONS
�(We) ��-�"°`�""-"`°-• (� �-�^-+�-�-�-�Q • ����. certify that on the 1st day of
vlarch, 19 �`% 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 (� �(p — �/ / 3�
O are buying under contract
❑ have a beneficial interest in the taxpayer �-7—�
Property Description in G-`'G-`�^� County O�`��� Township
Taxing District (Cii�,-�evrn-Township): ���`-
Parcel Number
If buying on contract: Owners na
or legal description shown on tax statement: /
Vf. /V E��� �'CcJ �.� Z-i� l' 7�J A�
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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
' hereby certify the above statement is true, correct and complete.
��,¢' vl // �/ �/Lii�Z(v� r�L�
'Signature Street naaress Ci�y. Scaie ana Zip CoEe
' 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 Improvements Dwellin�
��:ni � �
:-u<: „ � � age
� Total
Other improvements �
vti
Tr• Improvements - Line (6) plu (7) equals (8�
R Di?�
I��y certify the above is true. correct. and compie�e.
Siq:umre o1 nssesmr
1D
True Cash Assessed Homestead
Value Valuation Valuation
(t) y oo / 70
(2) / 8 (n o �4�=��1��
(3) � 3 � c� lOIo�,3�p�
(a) $ S "7 0 �%��!!�!i��%//�
(5) -
(g) $ S7 0
(7) � 70
�8� i�f�o
- ACTION BY AUDITOR -
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't r r
C�- /S-7y
Date
Da te: � - � Z - � "1�