HomeMy WebLinkAboutHomestead_Belcher (5)FOFM HC 10 1979
Prescri�e� By $taie BwrE a� Ta. Cammi55ioner5
To Be Filed in DuD���ate
CLAIM FOR HOMESTEAD PROPERTY TAX,CREUIT FOR YEAR 19 � 9 J
SEE BACK FOR FIIING INSTRUCTIONS d�/9-oo/SO-oa
�(We) �S" � ''��-'e'��`J certify that on the 1st day of
�vlarch, 19 I, (We) occupied as our principal lace of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: _
I, (We) O owned • -
❑ are buying under contract
� have a beneficial inter t in�ayer
i
Property Description in Co � Township
Taxing District (City, Town, Township): iL�wG.�.e-r...�
Parcel Number ' or legal description shown on tax statement:
fL►/Yn- • �/Yt�[ _ ��.'z i J�,�tY��
If buying on contract: Owners name �'� s""o1e °'""e0
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 thai
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 and complete. ���� -�'��
�� �c�, ��,�,,� yr� .� ��,,� �i���,� yy�
S�gna�ore Sveet Aaaress Gry. a�e ana LO 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.
Land not exceeding 1 (one
surrounding residential imp
Other Land
Total Land
Residential Improvements
- FOR ASSESSOR'S USE ONLY -
' b
) acre �11im�ia ly '� D
rovemd4ti�s
i�lv 121979
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Other Improvements
Tr' ' Improvements - Line (6) plus (7) equals (8)
I�by certify the above is true. corr�. and complete.
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51glUturP O� /155PSSOr
Approved
True Cash
Value
(�1 �%�O
(2) — o —
rs� / 7�—'0
(4) ���
(5)� ���
(6) �35X CJ
(7) — O —
(8) ��_4 a
Assessed
Valuation
�v �D
—b —
�80
Homestead
Valuation
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Date: