HomeMy WebLinkAboutHomestead_Colbert�
wAti+ xc �o ie,9
P�escriGeG By State Board al iax Commissfaners
CLAIM FOR HOMESTEAU PROPERTY TAX CREOIT FOR YEAR
SEE BACK FOR FILING INSTRUCTIONS
io Be FileC In Duplica�e
19�� �
o�q- 00�3,�• o0
,� '` � }b �. � T' V �.o... �_!�-�l-l'i-Q.t�-
(We = certify that on the 1st day of
arch, ;19—�_�. I, (We) occupied as ou 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 intere t in the taxpayer
Property Description in ��-�� Cou
Taxing District (City, Town, Township):
Parcel Number �
If buying on contract: Owners name "� s'"'o1e °'""e•�
Township
or gal scripti n shown on tax statement:9Sa.-c.n-��
z qW,V<F�W �I� �f-a-/D O
� lcUJ%<l /� �-/O . // �-o�
Q� GJ %¢ 7-a- /D .OGp,ctim�
Contract recorded in Recorders Office - Record
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.
'Signawre
0 2 �' .
Str¢p� AQdR55
County Township
�1.n-,... h-+r-��
p�,� e�Gn-� .11Y�� � `�7610
ci�y, ta�e ano Zio �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
surroundin9 residential improvements
Other Land � �
Total Land � � �
Residential Improvements Dwqelling
juy 1 � ��UaFage
Tota
Other Improvements
Tr•-' Improvements - Line (6) s(7 equals (8) pUQ�TOR
i�by certify the above is tr�e, c rect. and �mplete.
Signa:ure oi nssesmr
Approved
�:�
True Cash
Value
(1) / �' 8 �
(2) — � -
(3) / ��D
�4� �-
(5)S��4' l°'1-a
6 S� t[' "'
. .•
. �
i
%//////%///�%////%/
jj�
Homestead
Valuation
• � �/�/��jjj
� � � - � j/�jjjjjj�/
Date: �i? �./r -, �
: ,;, .-