HomeMy WebLinkAboutHomestead_EadsFOHM HL 10 1979
Prewi�ea By Sia�e Boa�a of taz Cammissione�s
io Be fileG in WpGCate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19� �
SEE BACK FOR FILING INSTRUCTIONS Ol�- oo?a3. o0
�.',We) � � � certify that on the 1st day of
�arch, 19�, I, ( occupied as our principal place f esidence the following described real property for
which a Homestead Property Tax Credit is hereby bei g claimed: �
I, (We) ❑ owned
❑ are buying under contract .
❑ have a beneficial �nterest in the taxpayer
Property Description in o��Lf'��
Taxing District (City,..Ie�vrr, Tewrishrp):�L
Parcel Number
nty �� Township
or legal description shown on tax statement:
.al n , l� ..L . .
If buying on contract: Owners name ��� simple ow�e,� /� Sw �/.?+�-�% -/3 � �
t� /t -3 -// . ,Z 2
Contract recorded in Recorders Office - Record No. Page
If any portion of the residential structure or the land, not exceeding one (7) acre that immediatety 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
hereby certify
above statement is true, correct and complete.
�
Township
ana Zip CWe
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 residenlial improv�tS� � � �
Other Land �
Total Land
Residential Improvements JUiV 1'� i979
�Dwe ling
�qV pMll
Other Improvements
�T•�� Improvements - Line (6) plus (7) equals (8)
by ceryi#� the a�ve is�ru� rrect. and complete.
. / 1
Signamre oi
True Cash Assessed Homestead
Value Valuation Valuation
(t) � �
(�)
�3, ��yo
�4� �o
�s� 3 3 o-"f-D
(6) ��-�-:—'�'
(�) �
(81 ��
- ACTION BY AUDITOR -
���������
,/,%%%�i�
� -
�
��///j�/�/
��jjjjjjjj
� —%�-7�
oa:e
Approved: �� lit2N-�a� Date: G -/9- � �