HomeMy WebLinkAboutHomestead_Lemmons (3)FOPM HC 10 1979
Prescri�eA By S�are BW�4 al ta� Commissfaners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 192�
To Be PileE in Duplicate
✓
SEE BACK FOR FILING INSTRUCTIONS o�q _ or�a ����
�(We) - certify that on the 1st day of
+iarch, 1�Q, I, (We) occupied as our p' cipal place of residence 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 yjterest in the taxpayer
Property Description i
Taxing District (City, Tc3wa—Towpshi�j:�,�
Parcel Number
If buying on contract: Owners name �`� 5inip1e °""ef�
�� � Township
or legal description shown on tax statement:
� ,���, � � z
Contract recorded in Recorders Office - Record
Ii 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.
a
�:
a
County
Township
'� /
ana Zi0 �e
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 -
True Cash
Value
Lantl not exce ing �(one�acr W� me - ely
surrounding residential improvemeflts � ��) ,� / d o
Other Land �� ,��
J 2 5 !9%9
Total Land
Residential I�ve nts
I, ,
RUDITOR
Other Improvements
(2) —
(s) // o 0
Dwelling �4� �
Garage �5> ��� 5L �
Total (6� '-�� �
(�) —
Assessed
Valuation
370
.
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T�Improvements - Line (6) plus (7) equals (8) (8) �Q-�-e� i�"��
I.._.sby certify� above is true. correct. and complete.
Signamre ol Assessar // // _
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� � /' _ - ACTION BY AUDITOR -
Homestead
Valuation
.
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