Homestead_WoodsFORM HC tU 19i9
Prts[ri�e0 By Sta;e Bwrd of Ta. Commissioners
7a & FileE in OuDlicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19-7 0
SEE BACK FOR FILING INSTRUCTIONS
�We)�/�1—��—�---�w, 1�Yu-�-�2�.�t- �e-Q-- f s�l���fy that on the tst day of
� arch, 19 � 9 I, (We) occu d as our principal place of residence the fol wing described real property for
which a Homestead Property Tax 'Credit is hereby being claimed:
I, (We) ❑ owned Ob(p -ball$
❑ are buying under contract
❑ have a beneficial intere/st in the taxpayer
Property Description in CT.c�-�--��. Counry ��d�� Township
Taxing District {6ii�yT-zawn, Township): ��
Parcel Number or legal description shown on tax statement:
�� i.
If buying on contract: Owners
Contract recorded in Recorders Office - Record
-z- io ..37A
. 0 8i9
ge
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: County Township
thereby certify the above statement is true, c rrec and complete. .
. � � �
Signat�.e Street A ress Gry. S�aie ana �o Coae
' 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 (� ��rr�fi8te��
surrounding residential ro m nts �' lJ
Other Land
Total Land JUN 211979
Residential Improvement /�(�`k=�/(/Gwelling
�� arage
�� AUDITOR
Total
Other Improvements
T�"� Improvements - Line (6) plus (7) equals (8)
i�eby certify the above is true. correct. and complete.
True Cash
Value
(�l /ii o
(2)
�3) / i i o
(4) /7 9Lo
(s) —
(6) / 7 'r/!o c
(�) �
(s) � 7 9Coo
Sigiuture o� /ssessa� /' U
v_ � ,� J - ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation �
��15 D �-a.�k D
��1 �
�S�a
�-/ 9- �
Date
Date: —�