HomeMy WebLinkAboutHomestead_ShoultzCLAI��1 FOR H(X�EESTEAD PROPERTY TAX CRQ)IT FOR YEAR 19_
H(X
SEE BACK FOR F1LIN6 INSTRUCT
019- �allc-�
✓
�1« /
� ra?, �-���+e) �Y Q r�n-. � that .on the lst day of
�'�ch, 19 , I, (P1e) occ.lmie3 as our princinal ��ace o� ies e the followinq�described real
0
�certy ior which a t�arestead �vperty Tax �edit is herehy �;*+; claured: )>
I, (We) �c�mai . c� � . \
� are buyinR under oontract
� have a beneficial interest in the taxpayer
Property Description, in �a Q'S�mM ��t]' T��-F
Taxing �District (City, �, 4bwrLShip) : � �'.[�M
Parcel thm�t�ei or legal description stnwn on tax statarnnt:
�- CJ2Q o� P 0.��... y��
.
Zf buyina on o�ntract: Oc,*• =�s r�ame (fee si�le cx�mer)
Oontrart remxtied in F�ooxder's Office - Record No. Page
If any portion of the resicl��ntial structure or the land, nat e�eedincj one (1) a¢e that
irm�ciiately surzvimds that stsucture is use3 bo p=oduce ir�cane, describe the use an? partion of
tiie pzoperty utilized to pxoduce imome
Fny other �unties in which individual owns or is birying real pxoperty: Oo� �mship
herehy c the staterent is true, oorrect ani ocar�lete.
`_ iq��e Street Address City, State a� Zip Cc
*Individual either owns or is buying imer a wntract' that pxovi.des he i.s to pay the
ProP�tY taxes on the residence� ar has a beneficial interest in the taxPayer.
- FOR ASSESSOR�S USE ONLY -
' Trwe Cash
Value
Iand not ex�ing 1(one) acre inanediately
surrourding residential i�mvacpnts (1) •
• ,- _ .
Total Land
P,esidential 7aprov�nents
Dwelling
Garage
(2)
(3)
(4)
(5)
Assessed
Valuation
////�������
��//�����/ ,
tlaneskead
Valuation
Totat (6) / D
other Irty�rovenents • (7)
Tc ' Irrorav�rp�ts - Li.ne (6) plus (7) e�uals (8) (8)
I heseby certify the above is true, carrect, airl cat�lete.
��ature of Assessor ��
- ACTION BY PUDITnR -
?worovec: �'( �l - 1) Date: �' f/� O�
�