HomeMy WebLinkAboutHomestead_Williams (11)FOAM HL 10 1979
P�eSCri�eC By S�ate Bw�a af ia. Commissioners
io Be Filea in Duo�icate
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT FOR YEAR 19 � y
SEE BACK FOR FILING INSTRUCTIONS
�(We) ��%%`Y-�c--�-l�.�--a-�n-✓ , �"`-0.� . / I. d- ��-ti+lf-c.��-certify that on the tst day of
��tarch, 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) LS owned �DID �(/�'S�
❑ are buying under contract �
❑ have a beneficial inte`�,�e�s�t in the taxpayer
Property Description in "�-'�^-�^ County �°-'�O'�z^ Township
Taxing District (C+Fy--�ewn, Township): �
Parcel Number or legal description shown on tax statement:
�d- . fU W���f >`-l' 2- � �
�9GSH�
If buying on contract: Owners name �`� "`"�1e °""e•�
Contract recorded iri Recorders Ofiice - 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 owris or is buying real property:
�hereby certify the above statement is true, correct and complete.
�/I'Q... O. _.�%a),�0,,.'._> �1 �`1 �
County Township
�!„ �76 >o
ana Zi0 �e
Individual either owns or is buying under a coniract 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 Lan� � � � �
Residential mprovemer�t„s
�••�„ � ta��
J � •-
Dwelling
Garage
Total
Other Impr�ov,.e�me�
T�'�' Imp�"o�ement's - Line�{b)?��7� equals (8)
I�eby certif �the above is�tq(IE;F�correct. and complete.
Signawre ol Assessoi
True Cash
Value
��� -� 3 0
(2) c�°'a
(3) /��
(a) / °.� 9 0
(5) —
cs) / 9 z �'/ o
(�)
�g� �g�90
R�1��:��tt����rt��i�
Assessed
Valuation
�/o
�
Homestead
Valuation
a�o
--�-��-o ;
/"'-
�-i9-�
oai�
� � I
I