HomeMy WebLinkAboutHomestead_Bolden (5)FOflM HC 10 19i9
PrewiCeG By Slate Baam of ia+ Commissioners
io Be FileC In Du0licate
CLAIM FOR HOMESTEAU PROPERTY TAX CREOIT FOR YEAR 192� �
SEE BACK FOR FILING INSTRUCTIONS Q� 9- DO�Oq• �fl
;� (We) ���-�/ $��a�.L�,� certify that on the 1st day of
�sarcfi, 19�, I, (W ) occupied as our principal place of residence the following described real property for
which a Ho estead Property Tax Credit is hereby being claimed:
I, (We)�ned
❑ are buying under contract
❑ have a beneficial inter¢e�st in� the taxpa�yer � {..-�� � �
Property Description in �U.�(1-d�o-r.J Po�nty ����`°'0.� Township
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners
or legal description shown on tax statement: �/o��•
��m�,G-�� � �.�+� . /a,cLt /�.�21�-/-•�'
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
� Sveec AaCmss p / / ciry. State ana Zio �e
/
Individual either owns or is buying under a contract that provides he is to pay ihe ro ert taxes
on the residence,. or has a beneficial interest in the tax r.
- FOR ASSESSOR'S USE ONLY - /� /1v�''�` �
� �,�.
/ �'
Land not exceeding 1(one) acre immediately
surroundin9;residential improvements ft
.,
Other Land
Total Land p`� � �
Residential Impro�me� k� Dwe�lling
vU� � 6 �975 Gargge
Total
Other Improveme �i/
T '-' Improvemen� �e e�t3ais (8)
I��by certify the bove is true��. and complete
Sigeumw o� nssesmr
True Casi�—
Value
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Date: � - ��'%�