HomeMy WebLinkAboutHomestead_Combs (3)wnr.+ Hc io iem
heuriUeU By Sta�e BoarO a� Tax Commi55ioners
To & FileE in Duplicaie
CLAIM FOA HOMESTEAD PROPERTY TAX CAEUIT FOR YEAR 192� /
SEE BACK FOR FILING INSTRUCTIONS O(Q� O�t/S�.00
? � T
�(We) �J' -�'�^-�- ¢��-^���-�'�-� � certify that on the 1st day of
arch, 19�, I, (We) occupied as our princip 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 interest in the taxpayer
Property Description
��-'-"�-°-� Township
Taxing District (City, Town, Township): �" �`�`-^^-�"`'""
Parcel Number or legal description shown on tax statement:
,Qi•.- . ;�%�.a- . 3� .
If buying Ofl contract: Owners name ��� simde owneq
Contract recorded in Recorders Office - Record
e
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.
.}"/�% ����` o-�.a�'Z f o 3 61/. L-�'it` 2So .�i �
County Township
= T�t/. /ni0 4�7�7a
, State ana 2ip Coae
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
�: ` � -�'
9 � �-,
< <
Residential Improvements � ��.g,yelling
JUP' � 9 �y
Garage
�,� To
Other Improvements '
T�mprovements - Line (6) plus (7) equals �R
I y certify the above is true. cor�ect. and comple�.
Signature ol nssessor
True Cash
Value
(�) �G 5�0
(2) _' ° _
cs> �� �o
�4> ��
�5� ��_ o
(6) �
(�) - o -
(8) �
„r.,J • �:�..
'r �/
Assessed
Valuation
:,•
.
.,
O%/D%%%//,/0,,��
,�/.,/,,,/i
/, o� ��� „
m,���,,, .,,
l��. .
—a—
� ��
lo - /�-
Dare
Homestead
Valuation
����'!�
Date: -/�-'� 5