HomeMy WebLinkAboutHomestead_TuckerFOflM HL 1099i9
Prescnbed By State Board ol ia� Commissfoners
7o Be File9 in �uDlicate
CLAIM FOR HOMESTEAO PROPERTY TAX CREDIT FOR YEAR 19�� %
SEE BACK FOR FILING INSTRUCTIONS
,�(We) �^ ��—« � � certify that on the 1st day of
�viarch, 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 �b� '� (�� 7 Y�
❑ are buying under contract
❑ have a beneficial int �r s�t ai�n the taxpayer
Property Description in �'�^ County ��� Township
Taxing District (City�nwn, Township): � � '-'�'
Parcel Number or legal description shown on tax statement:/
�7 �W���K S tiJ i�� �^'1. ��(Si1�
If buying on contract: Owners name ��ee s�mo�e ow�en
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.
i'�� iY, r%u.c.Ocs-�, l4 7't 3 B e�c /r'2 O�i;�,�,e,t.
County Township
'79�gnamre _� Sveet A�Oress Ciry. Scaie anC Zi0 CoCe
7/ • �ndfvid�l eithe��r is buying under a contract that provides he is to pay ihe property taxes
on the residence, or has a beneficial interest in the taxpayer.
FOR ASSESSOR'S USE ONLY -
Land not exceeding 1 (on�r�i�di� �
surrounding residential imp e nt
Other Land
Total Land
Residential Improvement�
JUh! 21 i919
� � well9ieg
Y'i
� AUDITOF�otal
Other Improvements
T�'-' Improvements - Line (6) plus (7) equals (8)
I�by certify the above is true. correct. and complete.
Signawre oi Assessor
True Cash
Value
�t� Sc c
�2� 7 c c
(3) / L c o
�a� �/ i sc
�s> a 9 0
�s� y y � �
�,� 90
(g) `��3°
- ACTION BY AUDITOR -
Assessed
Valuation
.�
i-
��������
jjjj�jj�jj�
Homestead
Valuation
���jjj�jjj
jjjjj�jjjj
�������
j���j�
.
sv � ���
1S-�a-
�/ O
� - is -�9
Oaie
Approved: � Ul� � .�i�Flj�.t'q Date: ���
1 �