HomeMy WebLinkAboutHomestead_DayFORhI HC 10 19i9
PrescriGeE By StaL BoarO ol ia� Commissiocers
CLAIM FOR NOMESTEAD PROPERTY TAX CREUIT FOR YEAR 1922
To Be FileO in DuD��ca�e
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� SEE BACK FOR FILING INSTRUCTIONS O�q_ �OS�'��Oa
�(We) �� t , u- certify that on the 1st day of
arch, 19 , I, (We) occ ied as our principal p ac of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We)�wned
❑ are buying under contract
❑ have a beneficial inter t in the taxpayer
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Property Description in��4�'Q�'`��' ) County ��j c- Township
Taxing District (City, Tnwufl�anrnship};�_t� ��--t��z-
Parcel Number or legal description shown on tax statemenh
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If buying Ofl contract Owners name ��� s�moie ow�eq
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: County Township
�hereby certify the a
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statement is true, correct and complete.
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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 im�ve � nts � � �
Other Land
Total Land
Residential Improvements
Other Improvements
!!�T! z 5 t�7s
Dwelling
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AUDITOR
R�ovements - Line (6) plus (7) equals (8)
certify the above is true. correct. and complete.
Asseswr
True Cash Assessed Homestead
Value Valuation Valuation
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- ACTION BY AUDITOR -
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Approved: ,�� ,��,,.g��-�� Date: �P � � —� S