HomeMy WebLinkAboutHomestead_Shaferwani Hc m �s:�
RescriCeG 9y Sta�e Baam ai Ta+ Cammissloners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�
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SEE BACK FOR FILING INSTRUCTIONS Or�� D�SS,3' �'O
'(We) .tN� certify that on the 1st day of
�vlarch, .19? 9 I, (We) occupied as our principal place o esidence the following describ'ed real property for
which a Homestead Property Tax Credit is hereby being claimed: �
I, (We) C�(7 owned �
❑ are buying under contract
❑ have a beneficial int res/t in the taxpayer
Property Description in ��o SO '�-� County ��T�KA Township
Taxing District (City, own Township): �R i ti' � c�o .J� •
Parcel Number or legal description shown on tax statement:
C��, ���. ��- • a ��
If buying Ofl contract Owners name ��� simo�e ownep
Contract recorded in Recorders Office - Record No. Page
If any portion of the residential structure or [he 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.
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Stree� nCOress
County Township
ci�y. Sca�e ar�E zio �e �
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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 i�ve�ents� � �
Other Land
Total Land
Residential Improvements .ivN2519t�
Dwelling
ge
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Other Improvements AUDITOR
Tr�-' �mprovements - Line (6) plus p) equals (8)
I�y certify the above is true. correct. and complete.
(�)
(2)
(3)
(a)
(5)
(6)
(�)
(8)
True Cash Assessed Homestead
Value Valuation Valuation
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