HomeMy WebLinkAboutHomestead_Wells (4)FORM HL 10 1979
Prewi�ed By S�ate BoarE ot Ta� Commissfoners
Ta Be FileO in Uuplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREOIT FOR YEAR 19 7�/
SEE BACK FOR FILING INSTRUCTIONS
�(We) �/I�Le"�; �`°`"���- ���-rY�---� certify that on the 1st day of
��larch, 19 �� I, (We) occupied s 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 beneticial interes�t�/in t�he taxpayer
Property Description in �_"�-�-� County
Taxing District (CiL�-Fewrr, Township):
�D6-bao�4
Township
Parcel Number or legal description shown on tax statement:
./� � �/7. si7�9)
/L z�� i�r 3- z–ir�
If buying Ofl contract: Owners name ��� simo�e ownep
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.
� , �� � �
�� r�. �
Srgn are Stteet naaress Ccy. S'�a:e arW LD �oae
' 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 iropr vem
Other Land � � � � �
Total Land _
Residential Improvemen}��y 1 51979 Dwelling
(/t � � � `�L�k r/.�-- Garage
'�ti Total
Other Improvements AUDI70R
Tr'-'-+^�provements - Line (6) plus (7) equals (8)
I�y certify the above is true. correct. and complete.
Signamre o� Assessor
True Cash
Value
�i� �—O o
(2) l-B-rP-p-
(3) /�7�'+�
�a� / / 9G o
(5) �
(6) // r9(oo
��� 330
cs� / 1 �- 9 °
BY AUDITOR -
�
Assessed Homestead
Valuation Valuation
�
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._
/ 70
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