HomeMy WebLinkAboutHomestead_PritchettFORM HC 10 7979
PreSCriDeO By SWte Boa�a of ia. Cammissionea
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19z�
INSTRUCTIONS
To Be FileO in Uuplicate
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•� (We) � , � n. certify that on the 1st day of
��tarch, 19�Q, I, (We) occupied as our principal 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 beneticial i terest in the taxpayer
Property Description in =�-e`a-�-�-+ County /�� Township
Taxing District (City, T.own_ Sivanship): �il � O�
Parcel Number or legal description shown on tax statement:
�.S', � .P 3
If buying on contract: Owners name u� simo�e o�en
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
�'� y7G�D
ana L CoCe
' Individual either owns or is buying under a contract that provides he is to pay ihe 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 Dwellin
JUl_ �� i979 e
Other Improvements
Tnt^� Improvements
b�by certify/fH�
$i9nd�U�P OI A552550�
Garage
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AUDITOR
- Line (6) plus (7) equals (8)
above is true. correct. and complete.
True Cash
Value
(�l � o0
Assessed
Valuation
0
(2) — —
(3) aZ Oo 70
(4) -3.�_q'��
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�s>
(�)
($)
- ACTION BY AUDITOR -
.,,
/o
Homesiead
Valuation
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0
G —.Z-z - 7,
Daie
Date: 7' / ' 7 9