HomeMy WebLinkAboutHomestead_BellwAn+ xc m �e�s '
ReuriDeC By SWte BoarE of Taa Gommi55ioners
CLAIM FOH HOMESTEAO PROPERTY TAX CAEDIT FOR YEAR 19 79
To & FileE in WOlicate
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SEE BACK FOR FILING INSTRUCTIONS 0(G�� OO�%%-O D
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��y,�e) (�ARG ���Eu[AS/ /' �ELL certify that on the 1st day of
March, 19 75 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) �owned
❑ are buying under contract •
❑ have a beneficial interest in the taxpayer /�/-�
Property Description in ���5�^� County �/'�TO.eA Township
Taxing District (City, Town, Township): ���✓�e:a.✓ i�i✓n/Px /o
Parcel Number or legal description shown on tax statement:
�iKE Ei✓LC. OrcTLoT �3
If buying Ofl contract: Owners name ��� simple owner)
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:
�hereby certify the above statement is true, correct _and complete.
County Township
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
T�otal Land � � � � �
Residential Improvements
.JUN ':_ J 19+9
Dwelling
Garage
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Other Improvements `� ' � �
Tc 'mprovements - Line ( plus (7) eq�I���8R
I�y�ertify the abo� is true. correct. and complete.
Signamre
True Cash
Value
(1) .�O,Zo
(2) �
(3) 3o z o
(4) 1�TTo
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(6) /�fie'
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Homestead
Valuation
Approved: %C_� _/�`L/����i Date: G `/i-7 9
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