HomeMy WebLinkAboutHomestead_Kirchoff�
wan� xc �o �e�s
RescriDed By Sute BoaN af Taa Commissioners
CLAIM FOH HOMESTEAD PROPERTY TAX CAEDIT FOA YEAR 19 8�
To Be FileG in Dupliwte
✓
SEE BACK FOR FILING INSTRUCTIONS o�q _ m�Ygy _o�o
�1 (We) '-``�"`��`-`--��°�''�`"t /`r ' �� - ��^�-eertify that on the 1st day of
��iarch, 19 g� (We) occupied as our principal place of resi nce he 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
�'f .c�..��..
Praperty Description in �i
Taxing District (City, Tewt+—Tawnship):
Parcel Number
If buying on contract: Owners
`� �""�'�-'" Township
or legal description shown on tax statement:
�� N�-� .' 3
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:
certify the above
is true, correct and complete
snee� noaress
County Township
CitY. State an0 2ip Cotle
' Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a benefici�l interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY
Land not excee ( ) diately
surrounding res�ti�i p o�e ts
Other Land
Total Land triRZ `•�? ���='
Residential ImR�ro�ve�en}so
LTc.xs..l
AUDITOR
Other Improvements
True Cash
Value
( � ) / �-a--�
(2) —
�3� /'�e—o
Dwelling (4) '�"��t��—
Garage �5� / �7'� D
Total ` �6>
To�°� Improvements - Line (6) plus (7)� equals (8)
I�by certify the above is irue. correct. and complete.
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Signamre oi Assesmr
(�) �
(g) fsr°"°
-.ACTION BY AUDITOR -
Assessed
Valuation
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Homestead
Valuation
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Date: