Homestead_VoreFOpM HC 10 1979 To & FileO in OuDlicate
PreuriEM By Sute 8oartl af Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOH YEAR 19 ��
SEE BACK FOR FILING INSTRUCTIONS
�(We) ��a'4--�- /�Z-� �� °� ���--G�-�- � certify that on the tst day of
�varch, 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
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description i
Taxing District (Cii�4�ewrt;-Township):
Parcel Number
If buying Ofl contract: Owners name ��re simo�e owner)
om� -�a���
Township
or legal description shown on tax statement:
� A�
�v`-. E 4 !t/ � �/y / G - 2 - /�
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
� ii i i I n., n
3
naa.ess
County Township
Ciry, State and Zip Code
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 �on� acre.imm�rate�
surrounding resident im over{�,ents
l�o
Other Land
Total Land
Residential Improvements
��
Other Improvements
ILN ? , 1919
Dwelling
�/�i"_`-�'�'c �-G a r a g e
AUDITOR Total
To' Improvements - Line (6) plus (7) equals (8)
�'�oy certify the above is true. correct. and complete.
Signawre ol nssessor
Approved
�C,tc.[a.l-`c.
True Cash
Value
(1) � o 0
(2) s�v
(3) Ss�o
(4) �'�-o
(5) —
(6) ,f'�i-�-
(�) �
�g� /�'--�-
- ACTION BY AUDITOR -
Assessed
Valuation
/ �o
i �
� - �I
Homestead
Valuation
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Date: � �979