Homestead_WalkerFOflM MC 10 1979
heu�i0etl By Slate BwiE oi TaR Commissioners
CLAIM FOR HOMESTEAU PROPERTY TAX CREUIT FOR YEAR 19 � 9
io Be Filed in Dupli[ate
�(We) �r a-'�'�� ��-^�-��" • `T �,�^-�-��• certify that on the 1st day of
alarch, 19�, I, (We) occupied as our principal place of residence the following described rea� property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We)�ned ,f]O� —UC a�3 y
❑ are buying under contract v
O have a beneficial inteqre-s�t in� the taxpayer T L
Property Description in 1`''�""a-"'� County �O'-�-�'�`� Township
Taxing District (G+i�y�-�awff Township): ��
Parcel Number or legal description shown on tax statement:
��2 .Ur,✓% �"Z-�o ( Sf��
If buying on contract Owners name �'� ""'o1e °w"ef�
Contract recorded in Recorders Office - Record
If any portio� 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.
�1 1 `// �/ � I�n.a/%!L // � l � d.�/lA_ �n Ka
County Township
� 7�070
� Screet naoress G�y. State and Zip CoOe
� �. �w
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 resitlential impr�em�ts � � �
Other Land
Total Land
Residential Improvemenls
Other Improvemenls
_I U?� � � 19%9_
Dwelling
������
�' ' o a�
AUDIYOR
T�'"� Improvements - Line (6) plus (7) equals (8)
,�by certify lhe above is true, correct. and complete.
-. �.
Sig�Nre oi Asseztor ��
%
Approved:�
True Cash
Value
� i � S•'o'o
(2) ��'
�s) i f-�{-a—
c4) � � � i o
(s) T-
(6) i�S'/ �
(�) �
(8) /`f8/o
- ACTION BY AUDITOR -
Assessed
Valuation
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E
Homestead
Valuation
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oa:e
Date: CQL��/ ! /
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