HomeMy WebLinkAboutHomestead_Wildtwwn xc io �s�s
PrescdDed By Sute BoarG ot Taa Commissioners
To & FiIW in Duo��w�e
CLAIM FOA HOMESTEAD PROPEATY TAX CREUIT FOR YEAR 19 /�!"
SEE BACK FOR FILING INSTRUCTIONS
�(We) ���� /�-�1� n- ' Q �" `""`-�-��certify that on the 1st day of
arch, 19�°�, I, (We) occupied as our principal place of residen the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned oO� � �p�'�7
❑ are buying under contract
❑ have a beneficial intereQs�t in�the taxpayer
Property Description in /�-�-�`-0-�� County �� Township
Taxing District �G' , hi . ���--'h-o—
Parcel Number or legal description shown on tax statement:
� � � E -� • ��/ .�'� -�-�e �Si.itiA)
If buying Ofl contract: Owners name ��� simv�e owneq •
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.
� .
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(dne) �re irhmedi�y �
surrounding residential improvements
Other Land .���� � � ��79
Total Land
Residential Improvements� ��/
,� welling
AUDIT�Rrage
Total
Other Improvements
To,�lmprovements - Line (6) plus (7) equals (8)
I��by certify the above is true. correct, and complete.
Sig�uture oi Assesw�
True Cash Assessed Homestead
Value Valuation Valuation
(�) •SCo �� / 90
(2) 8` 8 7 0 -' �`�s� ,�
(3) C/� %O
(4) %� SS�o
(5) / / So
(6) / %7�.0
(7) 3 7 �%o
($) � � y Ga �
;TION BY AUDITOR -
S3�
��
/ O ZZ�
�-�9-7
Da�e
Approved:� Date: � — ,,,� �- 7 y
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