Homestead_West (4)wan� xc ia i�v
Preuri6M By Sute BoarE of 7aa �Commissioners
To & FiIW in Wpliwte
CLAIM FOR HOMESTEAD PHOPERTY TAX CREDIT FOR YEAH 19Z
SEE BACK FOR FILING INSTRUCTIONS
�(We)�1�, �f�h-c�- � certify that on the 1si day of
arch, 19 � I, (We) � cupied 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 bD� oaQ73
❑ are buying under contract
❑ have a benefici nterest in the taxpayer �j
Property Description in �L°-�� County \�7 � Township
Taxing District (C�t�Few� Township): ���-�-^-
Parcel Number or legal description shown on tax statement:
l7f• W //-� illF ��y �0-2- // .8?3 j
If buying on contract: Owners n
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:
�hereby certify the above statement is true, correct and complete.
n
svee�
County Township
State antl Zip
ividual 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 -
E � True Cash
a Value
Land not exceeding 1(�e) aEre immediately
surrounding residential improvem�t22.9�9 (�) / o
Other Land �U (2) —
Total Land
Residential Improvements� � elling
AUDI7�I�
Garage
Total
Other Improvements .
To�mprovements - Line (6) plus (7) equals (8)
I y certify the above is true. correct. and complete.
$i)11d1uIp OI ASSPS50!
(3) L// o
(4) � �' fi S J
(5) -
(6) aa BSo
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(8� � �
Assessed
Valuation
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Date: "� - ��' / /