HomeMy WebLinkAboutHomestead_Lewis (6)ww.+ xc �o �er�
HescriGCd By State BoarE ol Ta. tammissioners
CLAIM FOfl HOMESTEAD PflOPEflTY TAX CREUIT FOR YEAA 19��
ro ee Fam �n wvrw�e
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SEE BACK FOR FILING INSTRUCTIONS Q(L�_ D�6/ g_�
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�(We) � certify that on the 1si day of
� arch, 19 I, ( e) occupied as our princi place of residence the tollowing described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) L� owned
❑ are buying under contract
❑ have a beneficial in�ter�est in the taxpayer
Property Description in ,cs�LC� County _���� Township
Taxing District (City, T�swr�-Fewaship): ��-�.-.-�Q��
Parcel Number or legal description shown on tax statement:
" � x9
If buying on contract: Owners name (�� SimD�e owner)
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:
reby certify the above statement is true, correct and complete.
�
Street Aaareu
County
c
Township
� � 5�7�76
Ciry. S�are ena Zip CoEe
' 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 exceedin�fi (oge ) acTe im �iaf'
surrounding reside�t�a'I irt��rov�ents�
Other Land
Total Land .!:1N 2. ] 1919.
Residential Improvements
�� �� Dwelling
, , _ .�?-dit.oy Garage
� ?UDITOR Total
Other Improvements
T�Improvements - Line (6) plus (7) equals (8)
I..,,_oy certify�e above is true. correct. and complete.
I fl_ i_
$i9ndW�P O� A552550�
True Cash
Value
(i) dZir�o
(2) _.
(3) a / a D
(4)1�s�o
(5) 1 �-170
cs� /�B'
c�� �—�
(g) � �''�f
- ACTION BY AUDITOR -
Assessed
Valuation
� D o
. .
Homestead
Valuation
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6-�Y-Ty
Da�e
Date: