HomeMy WebLinkAboutHomestead_Fortner (3)wRn+ nc io ism
RescriUeE By SUte BwrO ot Ta. Commissioncrs
CLAIM FOR HOMESTEAU PROPERTY TAX CREUIT FOR YEAH 19�,�
ro & Film in Dupliwte
�
SEE BACK FOR FILING INSTRUCTIONS Q l(� � D p$ L� a��OS�
'(We) J� ��. °'f" �� � certify that on the 1st day of
march, 19�, I, (We) cc ed as our principal place o residenc� ing described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contraci
❑ have a beneficial in rest in the taxpayer
Property Description in e � County ��— Township
Taxing District (City, �ewn, �ewnship): ,�i1-�.-�
Parcel Number
If buying on contract: Owners name ��� simole
or legal description shown on tax statement:
�,°r ° Zv z s- � .� �
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.
County Township
Ie "- ' J� " - Sneet AEaress - � '" Ciry: State ana Zio �e
V 79•G-/�
' 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 immetliately
surrounding residential improvements
Other Land
Total Land � � �
Residential Improvements �w " li
Garage
-`��N - � 1979Tota�
Other Improvemenis
Tr� Improvements - Line (6 p �(7�k8��
I�by cert the above is ue. correct. ����r�plele.
i n i
Sigiature of nssesmr
True Cash
Value
(�) �300
(2) '—
�s� � 3 0 0
(4) / " `a--v ��
cs, � 9 3—�.D
�s� �
(�) `
(8) /�D
- ACTION BY AUDITOR -
Assessed
Valuation
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Homestead
Valuation
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Approved: � �' ��c.�� Date: � � 9-7 9