HomeMy WebLinkAboutHomestead_Bailey (5).
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FOIiM HL 10 1979
heuriDM By Staie 8wN of TaK Commissioners
CLAIM FOA HOMESTEAD PROPERTY TAX CREUIT FOR YEAR
�� ,f, SEE BACK FOR FILING INSTRUCTIONS
,�1.� � n/ E /-�n� �sFic cy
�FileG in Duvlicate E.
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19 �s �-� ,;�-�
'� 4�/ 8 �
0�9- Ooo��,-oa r-y'
�(We) " '4"��`� � certify that on the 1st day of
arch, 19J�, 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)�wned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in ��3�^f Count �T°KA Township
Taxing District (City, Town, Township): ����✓cETO�✓
Parcel Number or legal description shown on tax statement:
S. S. /�t7���J /37 �i3 8
If buying on contract: Owners
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
'!�f-/L��/ .Sm/anl i:, 0.=av. �.� no,nn.=o.L,� --Lb,,'._ �� il
Any other c�ounties in which individual owbk or is buying real property:
;here certify the abov statement is true, correct and complete.
� S .
'Sia awre Street naaress
County Township
�" � � 76 70
Ciry. S�aie ana Zi Cooe
' 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 JUN 2'! i979 Dwelling
/� Garage
`� 1 • �/��1c,Q� Total
Other Improvements AUDITOR
u' Improvements - Line (6) plus (7) equals (8)
,__�6y certify the above j� true. correcl. and complete.
5lgnamre
True Cash
Value
(1) 700
(2)
(3� 70 0
(4) ''�
(5) 5� i�'�%O
(6) �
(7) 2�.So
(8) '�°
Assessed
Valuation
<23 0
�� /8
Homestead
Valuation
�3d
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Date: �