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HescriheE By Slate Board of Taa Cammissioners
To & Filed in Duplicate
CLAIM FOR NOMESTEAD PAOPERTY TAX CREDIT FOR YEAR 19�_ �
^ SEE BACK FOR FILING INSTRUCTIONS �/ 9- Q� 8� �� OO
�(We) ��'1� certify that on the 1st day of
dfCh, 19� I, lWgl nr_.r_.iinigri as niir nrinr.inal nlacg nf rasitianca ing fnllnvying deSCfib@d f0al property fof
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial inter t in the taxpayer
Property Description in � -+��
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners
o.�e��
Township
or legal description shown on tax statement:
�1.� �2��z.
Contract recorded in Recorders Office - Record No. Page
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
�-��� �,��y �s�E�x .�- —�— �� �.�.�r�,_,. �� �� y��o
'Signature Shre� AGGress Qry. S�a�e anC LO �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 beneticial in[erest in the taxpayer.
- FOR ASSESSOR'S USE ONLY
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land � � � � �
Total Land
Residential Improvements Dwelling
True Cash
Value
(1) `i90
(2) — o —
(3)
(4)
JUN ? : 1979 Gara9e �5>
//�`�`� Tolal
�i
Other Improvemen s /��T ' AUDITOR
T^•°' Improvemenis - Line (6) plus (7) equals (8)
I�-by certify the above is true�orrect. and com�
Sigwwre of Asussor
Assessed
Valuation
�o
_., �
Homestead
Valuation
cs> 7 0 ��c
(7) O
(8)
�
JDITOR -
0
G - �/ - �,9
Da�e
Date: � f_�