HomeMy WebLinkAboutHomestead_Alvis (3)FONM NG 70 7979
PreuriGeG By State Baard af Tax Commissioners
CLAIM FOR HOMESTEAD PAOPERTY TAX CREUIT FOR YEAR 192`L
To & FileE in Duplipte
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SEE BACK FOR FILING INSTRUCTIONS 0/(!- QOOl.�/.00
�(We) �""_"' �' �'" �`�-�`� certify that on the 1st day of
arch, 19 I, (We) occupied as our princi al place of residence the tollowing described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) I(� owned
d are buying under contract
❑ have a beneficial inter st in the taxpayer
� �� Townshi
Property Description in � ounty p
Taxing District (City, Town, Township):
Parcel Number
If buying Ofl contract: Owners name ���' simple owne.l
or legal description shown on tax statement:
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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: County Township
�hereby certify the above statement is true, correct
� ., � // , n
complete.
' 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 ; �07�
JJIV � = `�.
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Other Improvemen�ts ,�UDITOR
Dwelling
Garage
Total
T Improvements - Line (6) plus (7) equals (8)
I��by certify the above is true. �rect. and c
Signature ol Psseswr
App
��7v
True Cash Assessed Homestead
Value Valuation Valuation
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Date
Date: �-��°�9