HomeMy WebLinkAboutHomestead_BaylerFOpA1 HC 10 1979
heuriDeU By State Board of Taa Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREOIT FOR YEAA 19��
To & FiItO in Wplicate
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SEE BACK FOR FILING INSTRUCTIONS orq- oo�a�_ o0
�� We) C/��e�-A/c.P-C�d' f✓�' J}" !/� /l,� 6��-�-t/certify that on the 1st day of
rch, 19�, I, (We) occupied as our principal place of residence t e following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
E� are buying under contract .
❑ have a beneficial i e est in the taxpayer �/,-y�-.�� / '
Property Description in x� �nty �J�.�c.�i�-a�J Township
i . �. .
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners
or legal description shown on tax statement:
� .�. CL�� . /3 � ,� .
� . ., - - , , .
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
Any other counties in which individual owns or is buying real property:
hereby ceriify the above statement is true, correct and complete
County Township
✓
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" Ciry. 9are a�q 2io e
' 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 -
True Cash
Value
Land not exceeding 1(one) acre immediately
surrounding residential improvements (�) .��"�
Other Land � � � � �
Total Land
Residential Improvements Dwelling
,�, ,, _ ;�,9 .
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Garage
Other Improvements � , /��al
�-���� Improvements - Line ( plus (7) e�4�T(�{�
�y certiTy the above is true. correct a�i d complete.
XI ��
Signa:ure ot Asussor
Assessed
Valuation
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Da:e
Homestead
Valuation
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