HomeMy WebLinkAboutHomestead_Stone (4)fOPM HC 10 1979
PrewiGea By State Boara af iaa Lammissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 �9
70 & Fiiea in Duoiicate
✓
SEE BACK FOR FILING INSTRUCTIONS �!(r� �agOp_00
�(We) ��-�--�-� ��^`-^--e-�- �- ���-�-�• certify that on the 1st day of
Aarch, 19�L, I, (We) occupied as our principal place of residence t following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We)�owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in �� Counry ��-� Township
Taxing District (City, own Township): O�� �� -^" #9
Parcel Number or legal description shown on tax statement: .
� � �,- �•S'�..,, . .L � �9 fi Sv�.
If buying Ofl contract: Owners name �"'� s'"'o�e ow�erl
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
Individual either owns or is buyin9 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 -
True Cash
Value
Land not exceeding 1(one) acre immediately + 7/ o
surrounding residential i`�m'�prove"�nentS� � � ��) `�
Other Land (2) —
Total Land JUN 2 5 1979 (3) ��
Residential Improvements
, ���
/ ,ir���=�u elling
� a�age
AUDITGTotal
Other Improvements
Tn� � Improvements - Line (6) plus (7) equals (8)
I�by certify the above is true. correct. and complete.
(41
(s)
(6)
(�l
($)
��
Assessed Homesiead
Valuation Valuation
t�� o �tr o
�a `/ o
� _ �s-�y
Da:e
Date: �g/� / ( �