HomeMy WebLinkAboutHomestead_LepageFOflM XC 10 1979
Re5tri6M By State BoarE ol Tae fqmmis5ioners
To & FileE in MDlicate
CLAIM fOR HOMESTEAU PHOPERTY TAX CAEDIT FOR YEAR 19_� •
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SEE BACK FOR FILING INSTRUCTIONS Q�9 – DI�p��' �O
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�(We),T � . ��!� ' certify that on the 1st day of
ivlarch, 19�� I, (W occupied as our principal 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 in rest in the taxpayer
Property Description in � , County ,� � Township
Taxing District (City, Fowri; Tewaship): /d���
Parcel Number or legal description shown on tax statement:
���� 1�.��d� , -z 7 �
If buying on contract: Owners
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: County Township
� hereby certify the above statement is true, correct and complete.
' 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 -
J�IV � L t9?J
Land not exceedinq 1(one) acre immediately
surrou ing r sid I im r ements
Oth�n , /�� �
Total L d ql1D R�J��
Residential Improvemen 3 �
2��3
Dwelling
Garage
Total
Other Improvements
�Improvements - Line (6) plus (7) equals (8)
I_.._�eby certjfy�the above is true. correct. and complete.
Sig�uwre oi
True Cash
Value
c>> / 7� o
(2) —
(3) / 7la O
3B(� '��
cs> %�o �`s'�S O
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(�) �
($) � � 9
- ACTION BY AUDITOR -
Assessed
Valuation
s' 9 0
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Homestead
Valuation
�—iy— 7%
Date
Date: —!J � �� � / �