Homestead_WhittenFOflM HC 10 79i9
Prescri0ed By Sta;e Baa�tl of ia. Commissioners
To Be Filea in Uu0licate
CLAIM FOR HOMESTEAO PROPERTY TAX CREUIT�FOR YEAR 19 �9
SEE BACK FOR FILING
described real properry for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) Q'owned ��(�J -aa � a q
❑ are buying under, contract
❑ have a beneficial interest in the taxpayer
Property Description in '��-a--rr. �� A ��`-^- Township
Taxing District (Cii�y--�awn, Township): ���-�£-�>
Parcel Number or legal description shown on tax statement: / �
V �• � // �� % � /oy
Z �f / 8' 2 —iD
If buying Ofl coMract: Owners name ��� s�mo�e o..neq
Contract recorded in Recorders Office - Record No
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
struc ure is used to produce, income, describe the use and portion of the property utilized to produce income
0
Any other counties in which individual owns or is buying real property:
�hereby certify the above statement is true, correct and complete.
���� ou �e ri�
_.9nawre �'� � �� S:ree� AaCress
m
County Township
O� C
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► �7G 70
Ci;y. Sta:e ana Lo �e
Individuat 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 exce�ding 1� (one� acre�imme � tely
surrounding res���nti�l imp�veme�nts �
Other Land
Total Land ��:��� 2 � i�79
Residential Improvements Dwelling
�����1��� Garage
AUDITOR Total
Other Improvements
Tr��'-.Improvements - Line (6) plus (7) equals (S)
f�by certify the above is true. correct. and complete.
True Cash
Value
( t ) Sa� o
(2) a�3o�
(3) 3 0 3 0
�a� �� �i c
(5) '_
(g) ��'��v
(7) � � 7 c
ca> � �� S o
Slgnawie ot Assessor( / V
�� - ACTION BY AUDITOR -
_ . . /� .,
Assessed
Valuation
l90
�%/O��—
Homestead
Valuation
i7o
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7
Dateii'�� l%%�