HomeMy WebLinkAboutHomestead_BrightFOqM HL 10 7979
heuribe0 By State Board of Tax Commissioners
To & FiIM in Duplrcate
CLAIM FOR HOMESTEAU PROPERTY TAX CflEDIT fOR YEAR 19Z� �.
SEE BACK FOR FILING INSTRUCTIONS Q�9'– O���J�`�9
� � e- 2��J � � ��.t
�(We) � z�— certify that on the.lst day of
arch, 19 I, (We) occupied as our princip I place of resi ncetl2 the tollowing described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
O are buying under contract
❑ have a beneficial inter st in the taxpayer
Property Description in �
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name ��� SimD�e o.�e.r
�� Township
or legal description shown on tax statement:
. K.�(�t�v..o-sL� �-CX-OL. ! l
Contract recorded in Recorders Office - Record No
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: County Township
' hereby certify the above statement is true, correct and complete. -
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'1/�,,n.r.[�, A � G/� ,E'_ �.Lf�i�Cr s %–. >r�Gr,�4.�-, �'b. <
�S�gna�ure '- Svee� AaEress Ciry. State a�M Zi0 �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 -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
oohal Lan� : � � k�s� � �
Residential Improvements ,f979
,�UN 1 � _--
Dwelling
Garage
�% Total
Other ImpF�(�m � Q�DITOR
T.^ Improve nls - Line (6) plus (7) equais (8)
I`�by certity the above is try� correct. and c�mplete.
Signawre ot Assessor
True Cash
Value
(1) /�L90
(2) —D—
cs� �s�90
(4) � O
cs� s_�2°
(s) 5�0�'D
(�l �J
(8) �
Assessed
Valuation
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Homestead
Valuation
b-�-7�
Date
Approved:��1��t� _ Date: (Q �l/ �g
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