Homestead_Williams (14)FOPh1 MC 10 7979
HeStriGeE By Sute BwM at Tax Commi55ioners
To & FIeE in Wplicate
CLAIM FOR HOMESTEAD.PROPERTY TAX CREDIT FOA YEAR 19�
SEE BACK FOR FILING NS RUCTION
�(We) ^ - certify that on the 1st day of
arch, 19� I, (We) occupied as our principal pl e of residence the fo owing described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contraci
❑ have a beneficial interest in the taxpayer
Property Description in ,�<—�,
Taxing District (Cif�—Fewrr, Township):�
Parcel Number
If buying on contract: Owners name ��� SimD�e
bb� - ba rs.r
�°-�`�L-" Township
or legal description shown on tax statement:�
�¢ � E '/V S Lc> � `°` ' � 5/�i)
s� 3 - a —. a
Contract recorded in Recorders Office - Record No. Page
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:
�tiereby certify the above statement is true, correct and complete.
n
ACEress
County Township
Giry. State ana Zip
` 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 Dwelling
.1 �'�� ? � i 97�_
Garage
��/��� -�-- Total
Other Improvements� � � �
Tr�mprovements - Line (6) plus (/' ��f�� (8)
I by certify the abov�e is true. correct. and complete.
SiglWtu!¢ OI F55¢SSOI
True Cash Assessed Homestead
Value Valuation Valuation
(�) � p P / % o
(2) �� 27a ° ' P
(3) %�o +�"a�
(a> � 9 9 0 �
(5) — 's
�s> .� 9 9 �
(�� �
(8) � �1 �l o _
/70
�— 1 g—%%
Da;e
- ACTION BY AUDITOR -
1 Date: