Homestead_Tichenor (3)FOflM HC 10 19i9
P�escriDed By Sta:e Ewrtl of ia. Cammissioners
To Be FiIM in Duplicate
CLAIM FOR HOMESTEAU PROPERTY TAX CREOIT FOR YEAR 19 ��
SEE BACK FOR FILING INSTRUCTIONS
;� (We) �L�`-'^�� �� �� ��a-�-�-- certify that on the 1st day of
March, 192_�__. I, (We) occupi as our principal place of residen e the tollowing described real property for
which a Homestead Property Tax Credit is hereby being daimed:
�, (We) �owned 4�% � � OI ` �r -
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Oescription in ,� County � Towns
Taxing District (6ity,-�ewrr, Township): ���'%-�-
Parcel Number or legal description shown on tax statement:
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�C v/6-z-/i �5/a.q)
If buying on contract: Owners
Contract recorded in Recorders Office - Record
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.
n_ �r �� // ... 24_ . � � ,m" _ .1 .O �
a-/f-1y `'
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(onel ac e m�e�
surrounding residential �v�m ts
Other Land g
Total Land JU� �Z , �g79
Residential Improvements Dwelling
(/i . y'i ��rtit&?�t rage
� AUDITOR Total
Other Improvements �
7� Improvements - Line (6) plus (7) equals (8)
I�by certify the above is true. correct. and complete.
5lgnamre o� nssnwr
True Cash
Value
�, � so 0
(2) ls a 9 0
(s) � 790
(4) 5�`f3v
(5) -
(s> S/ �{ 3 0
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�g� � o SU
- ACTION BY AUDITOR -
Assessed
Valuation
r -
��.
Homestead
Valuation
� 70
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.24LO�
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Da;e
Date: —�/�
7