HomeMy WebLinkAboutHomestead_Miller (10)iOflM HC 70 1979
Preu�iCeO By State BaarE ol Ta� fqmmissioners
To Be FiIM in Ouplicate
CLAIM FOR HOMESTEAD PROPEATY TAX CREDIT FOR YEAA 19�� �
SEE BACK FOR FILING INSTRUCTIONS Q�9 � Q�� g O. OO
�(We) ���— "" ��certify that on the 1st day of
.rarch, 19��, I, (We) occupied as our princi I 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 interest in the taxpayer
Property Description
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name �'� �'"1p1e Oxne'�
v �O'�-� Township
, � i
or legal description shown on tax statement:
��d Q�. � o�
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:
�' hereby certify the above statement is true, correct and complete.
County
Township
afW Ziv Coae
' 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
Land not exceeding 1(one) acre�immediatef;y3 _
surrounding residential improvements
Other Land ,�
Total Land � �'"�Yti
Residential Improvements p���rOR
Dwelling
Oiher Improvements
T�'-' Improvements - Line (6) plus (7) equals (8)
I�by certify the above is true. correct. a�i i complete
$iqnaWr2 O� F55¢SSOr
�,, sso
Assessed
Valuation
��O
(2) o — —o —
(3) � ��n
Homestead
Vatuation
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Date: 'S � �9