HomeMy WebLinkAboutHomestead_Clark (7)wun nc io ism
Reuri�eC By Stah BwrO ol Tae Cammissioners
To & FileE in Duplicare
CLAIM FOR HOMESTEAD PROPERTY TAX CAEDIT FOR YEAR 19 � v
SEE BACK FOR FILING INSTRUCTIONS O��%� O�Y� /� �O
�(We) �-�^'`�-°-' �� �� �"""--"�- �• ��^"''� ceriify that on the 1st day of
aarch, 19 ,(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) owned
❑ are buying under contract
❑ have a beneficial 'nterest in the taxpayer �/y�
Property Description in ��� County `�' � Township
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name �'� "nip1e °'"ne`�
or legal description shown on tax statement:
� /BA����%
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 comptete.
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
Other Land
Total Land �� � �
Residential Improve�nts�
;UN 4 I 1979_
Dwe�lling
Gar2'ge
Total
Other Improvement� ����c,/i��
, �
T� Improvements - Li (6) plus (7Q�q6� (8)
I�Dy certify the above is true. corr�. and Complete.
True Cash
Value
�l 0
Assessed Homestead
Valuation Valuation
(1) //�d <390
(2) — a =
(3) �/%D
(4) ��"
�5� /SP��3o
cs) !�d
(7) —o�—
(g) �
Signamre of Asseswr � �
- ACTION BY AUDI OR -
.
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Date: �-2%-�S