HomeMy WebLinkAboutHomestead_Minnis (8). lu bc ! I.J iv Oiql..itc
P2xiiCeO By Slaie BwrE of la+ Commissioncrs
.• -� CLAIM FOR HOMESTEAO PROPERTY TAX CREUIT FOR YEAR 19� ✓
' ? . ' --; " SEE BACK FOR FILING INSTRUCTIONS ✓��q-�3303 -�`>o
V�/��.. . . . � . ' .�, � . •�n . '
�Ne) �' certify thal on the 1st day of
ch, 19�., I, (We) occupied as our p' i place of residence the following described real property for
which a Homestead Properry Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract •
❑ have a beneticial interest in-the•taxpayer
Property Descripiion in County Township
Taxing District (City, Town, Township): ��( /Y>
Parcel Number , or legal description shown on tax statement:
- 40� �Ic9�1115���
��;� � -�
If buying �Ofl�contract: Owners name ��ee simple o�neq
.0 � ,� . ,,
. ' .'. �.• Contract recorded in Recorders Of(ice - Record No. Page
If any portion�of�the ieni.dential 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.
County Township
+.y.b,��=. r . ... � _ . � . , , au rev - . G�y. Staie ana Lo Cooe
' 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(one) acre immediately
surrounding residential improvements
Other Land �
Total Land
Residential Improvements
True Cash
Value
(�l
(2)
(3)
Dwelling �4�
Garage �5�
Total �6�
Other Improvements
To��provements - Line (6) plus (7) equals (8).
I h �eoy certify the above is true, correct, and complele.
Signawre ol nssessor
(�)
�
- ACTION BY AUDITOR -
Approved: �%� � / � � �"L�—
Assessed
Valuation
oam
Homestead
Valuation
Date: ! _`/ � — � � _