HomeMy WebLinkAboutHomestead_Perry (11)-/d� FOFM,HC 10 1979 l��
� PresaiDN By $ta:e Bwra ol ia. Commissioners
CLAIM FOR HOMESTEAU PROPERTY TAX CREUIT fOR YEAR 19�Q
io Be FileE in Ouplicate
�
SEE BACK FOR FILING INSTRUCTIONS p�q - oalss` �'U
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'1 (We) � vL/Y�N� certify that on the 1st day of
1arch, 19 8o I, (Y� e) occu d as our princi�l pl�ce of.residence the fo�wing described real property for
hich a Homestead Property ax Credit is hereby being claimed:
I, (We).❑ owned _
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in � County ��� Township
Taxing District (City, Town, Township): �h.e�c-c��J Q�c„�-a-,�. /o
-- Parcel Number or legal description shown on tax statement:
.�"ti,�.c_ �.�._G- ol?'�,- #/ 1K.�,c
If buying Ofl contract: Owners name ��ee s�moie ow�erl
Contract recorded in Recorders Office - Record No
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 oi the property utilized to produce income
Any other counties in which individual owns or is buying real property:
I hereby certify the above statement is true, correct and complete.
County
Township
ana
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 ��ED
Residential Imp e Dwelling
True Cash
Value
�,� a�oo
(2) �
(3) 02 y�o 0
l4)
tdAR 71980 sara9e �5>
�� '� Total
Other Improv� � ���'�p'C.LS�fi
Total Improvemen�LinAe��b)��i s (7) equals (8)
I h Eeby certify the above is true. correct. and complete.
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Signa�ure
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(�l
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Assessed
Valuation
:..
•�
$
Oa:e
J
Homestead
Valuation
$O b
S
3-�3-soy ��
Approved: ,� 1d /�—�-�-e-�-�/� Date: �— 7� ��
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