HomeMy WebLinkAboutHomestead_Brown (24)iORM HC 10 7W9
PrescnCeG By S�ate BwrO oi TaR Cammissfaners
To Be FiIM in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREOIT fOR YEAR 19� �
SEE BACK FOR FILING INSTRUCTIONS p�q- ooa�o' ��
�(We) �' � �`"'�'N "� certify that on the 1st day of
\� �.iarch, 19 I, (We) occupied as ou principal place of residence the lowing,described real property tor
which a Homestead Property Tax Credit is hereby being claimed: ��V'
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial inter�t in the
r,
Property Description i
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owne�s name �'� "`"o1e °""e^
� V �2-.�
�� Township
or legal description shown on tax statemenY.
Q� �uJ `/'� %—a_/a , 2Sa.cJt.�.o
Contract recorded in Recorders Office - Record No. Page
If any portion of the residential structure or the land, nof 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.
'SignaWre
Snee1 Aaaress
County
Township
�
G:y. Sia:e ana Z�o �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.
� 3i ] : �X9 ��Y � ] : � F� � �Y �iL I � i
Land not exceedin 1(one) acre immediatel
surrounding reside�l i�prov�ent� �
Other Land
Total Land
Residential Improvements UN 1 1 1979_
Dwelling
�,�/'/ Garage
/� Total
(/ AUDITOR
Other Improvements
�'-' Improvements - Line (6) plus p) equals (8)
��y certify the above is true. correct, a'�d complete.
II A
Signawre ot Assesw�
Approve
True Cash
Value
(�l o�/�D
Assessed
Valuation
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Homesiead
Valuation
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Date: _�