HomeMy WebLinkAboutHomestead_Kirk (3)�flM HC IU 1979
/ Res[riUeO By Sta;e BoarO of ia. Commissianers
io Be FIeE in OuD���ate �
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT FOR YEAR 19 8° �/
SEE BACK FOR FILING INSTRUCTIONS O�C� � DI � b 9• ��
I, (We) �`'�'-^�-rc� � "�' a--�^-^� � � certify that on the tst day of
�4arch, 19 $ � I, (We) occupied as our pr' pal place of residence the foflowing described real property for
hich a Homestead Property Tax Credit is hereby being claimed:
I, (We) �owned
O are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in � County ��� Township
Taxing District (6i�q;-Town, Tewnship): Qh�r��,.�
Parcel Number or legal description shown on tax statement:
��z �a_e. �-�- �'�.�,— 3
If buying on contract: Owners name �'� "nip1e °"ne'�
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:
I hereby certify the above statement is true, correct and complete.
'SigeuWre
� � ' %7
���
SVeet AOEress
County
Township
Gry. S�ace ana
' 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(o°�!� iately
surrounding residential �ro nt��
Other Land
Total Lantl � j � ��
Residential Improvemy��/�, _ '--�"
. .
��( ��u �0� i
Other Improvements
�i)
(2)
True Cash
Value
.230
Assessed
Valuation
770
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Total Improvements - Line (6) plus (7) equals (8) (8) �
I hereby certify the_above is true. correct. and complete.
Signawre ot Pssessor
- ACTION BY AUDITOR -
��
���-�o
Date
7G
Homestead
Valuation
% 70
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Date: 3 ' � � — � �