Homestead_Whitehead (6)wun Hc �o �s�s
AescriOcd By Scate BoarG of Tae Commissianers
To & Filed in DuO��wte
CLAIM FOA HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 � 9
SEE BACK FOR FILING INSTRUCTIONS
�(We) `�y`��-�� \` � � �-�-�- certify that on the 1st day of
arch, 19�, I, (We) occupied as our princi I~alac of sidence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: _
I, (We) owned eo� -aa 13�
�❑ are buying under contract
❑ have a beneficial interes in the taxpayer
Property Description in County �� Township
Taxing District (City�own, Township): � �
Parcel Number or legal description shown on tax statement:
S,�k.,,� /�.�-� �.n-�. � A �'a�ii
—o�
If buying on contract: Owners name
Contract recorded in Recorders Office - Record
Ii 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.
,�i__� 0 � �/�.�,_ � ��3 �._,�a, o,�
County Township
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 improvements
Other Land
Total Land
Residential Improvements �. � � �Welling
� rage
,: UN = 7 1979 Tota�
Other Improvements
T ' Improvements
I oy certify the
$ig�N�ufC OI AS!¢SSOf
i
True Cash
Value
c�) l900
(p) —
cs� / 90�
(a) �3� 8�
(5) —
(6) 3 3 '7 S o
n� —
(8) 33780
I�omplete.
�
- ACTION BY AUDITOR -
Assessed
Valuation
(0 30
.
jj�jjjj/�j/
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� /• �
Dare
�a
Homestead
Valuation
% �o
7-rj
Date: _�.=.Z7-79