HomeMy WebLinkAboutHomestead_KemperFOFM HC 10 19i9
PrewiCea By State BwrO ol 7ae Cammisvoners
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT FOR YEAR 19��
To 8e Filetl in Uuplicate
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D, SEE BACK FOR FILING INSTRUCTIONS Q(9 —Qrf.�:{��0�
�(We) �� certify that on the tst day of
arch, 19�, I, (We) occupied as our principal place of residenc 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 inter st in the taxpayer
Property Description in ounty ��.e..� Township
�
Taxing District (City, Town, Township):
Parcel Number � or leqal description shown on tax statement:
� 2 yS'.� C1.�,CaC ..33 5� �3 3.�
If buying on contract: Owners name �'� �""o1e °w"e"
Contract recorded in Recorders Office - Record
If any portion of the residential structure or the land, not exceeding one (1) acre tliat immediately surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counlies in which individual owns or is buying real property: County Township
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' Individual either owns or is buying under a contract that provides he is to pay ihe 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
True Cash
Value
i . i
(2) —� —
(31 ���'�
Residential Improvements ��N �� �979 Dwelling �4�
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___Q �Garage
' � ����`k. _ U i otal
• � =diCRiL�
Other Improvements AUDITUR
T��' Improvements - Line (6) plus (7) equals (8)
I�by certity the above is �iue. correct. ar� complete.
Signature OI ASSCSSOr
�JI
(6)
(�)
(8)
Assessed
Valuation
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�S�O
Homestead
Valuation
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Date
Date: _ - a� 7