Homestead_White (8)hescuGeC By Siam Boa�a oi 7a. Cammi55lonns - �
CLAIM FOR NOMESTEAD PROPERTY TAX CREU�T FOR YEAR 195� !
SEE BACK FOR FILING INSTRUCTIONS
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�(We) `�' � " � w � certify that on the 1st day of
,rch, 19$`�. I, (We) occupied as our incipal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I.(We)Ni'owned ao� o��G3 °o�
❑ are buying under contract
❑ have a beneficial interest in the � taxPayer � -
Property Description in County - Township
Taxing District (City, Town, Township): ��°1�� �
Parcel Number ' or legal description shown on tax statement:
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If buying Ofl COQlfdtli��WflQfiS,Ftla'fT18 ��ee vmWe ow�e�l . t, • .
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. • Contract recorded in Recorders Office - Record No. Page
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If any portion of thy�Ce`�i�enti�l structure o� the land, not ezceeding 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
Hvv�.�••
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Any other counties in which individual owns or is buying real property:
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�—hereby ce ti(y the abo sta ement, is true, correct and complete'. �
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County Township
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� � au �e i . �nY. mare ana tip Code
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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 -
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Land not exceeding 1(one) acre immediately
surrounding residential improvemenls .
Other Land ' '' '
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Total Land ' .
Residential Improvemenis •�
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_ True Cash
., � .;. Value
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;� , . �', .(2; . . _
, ,. (3) ., .
Dwelling �4� .
':� � � ; I � Garage ., � �
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�•. i ; � Total -,�T.;
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Oiher Improvements � ' .
To��nprovements - Line (6). plus (7) ,equals (8) � � � ; � =:
I h:�ruy certify ihe above is true, correct.. and complete. . :.
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(8) � ' �
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$�9l�d�U�C OI /SSC550� � .
! - ACTION BY AUDITOR -
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Assessed Homestead
Valuation Valuation
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Date: � ��O ` � _