HomeMy WebLinkAboutHomestead_Whitehead (5)FOflM HC 10 1979
RcscriOM By Sure BoarO af Taz Commissioners
Ta & file0 in DupliCate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�
SEE BACK FOR FILING INSTRUCTIONS
�(We) ��`�-�t�� �� ��-a-�°�--� ��a^��— ��-�--certify that on the 1st day of
� arch, 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 bob— ��' � (
❑ are buying under contract
❑ have a beneficial inte�rJest �in the taxpayer �%
Property Description in �-°� County /� Ly � Township
Taxing District (City,-3ewar�ownship): `��
ParcelNumber or legal description shown on tax statement: ��aRG
�t . i(JuJ �i� ��- � — i o ��>
If buying on contract: Owners name ��� simo�e
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: County Township
�' hereby certify the above statement is true, correct and complete.
� �� � ��#� ��_ �--P � '��
'Sgnarore Street naaress Ciry. S�are and Zio Caue
` Individual either owns or is buying under a contract that psovides 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 t(one) acre immediately
surrounding residential improvements
Other Land �
Total Land � � �
Residential ImpYAVements �
�U,� u 519i9_
Dwelling
Garage
���ix"-K'�`" Total
Other improvemepts% �
/f �
Tc'�' Improveme�fits `�Line (6) plusil(��)1TeqBals (8)
I�oy certify the above is true. correct. and complele.
Signamre ol Assesm�
True Cash
Value
��� �o 0
(2) � � o
(3� �' 8 0
(a) / 5 '� i o
cs� —
(6) / SY! o
(�) � `� °
�g� / S90 �
Assessed
Valuation
�
_ .
�. •
��j�jj��/
���j���/
s•
= � -
. _
�
Homestead
Valuation
/ 76
�-� �i- �9
Date
`"' - ACTION BY AUDITOR -
Approved: /1 � V� 11�•'�c,� Date: 6�s/7/