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NeuriEM By Sute Board of ia. Cammissioners
CLAIM FOR HOMESTEAO PROPERTY TAX CREDIT FOA YEAR 19Z2
To & Filed in Dupliwte
i
SEE BACK FOR FILING INSTRUCTIONS ��Q-Op'tr]qO-0O
�(W�dG�cf��t?� `��a•,� �����2�,�"certify that on the 1st day of
arch; 19'I 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),ffi owned
❑ are buying under contract
❑ have a beneficial i erest in the taxpayer � o
Property Description in �-�-�� County �a��> Township
Taxing. District (City, �ewa-�ewasN+p): � Y�-�
Parcel Number
If buying on contract: Owners
or legal description shown on tax statement:
U,2� .�� � 9.e1
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:
� horahvi cerfifv iha ahnva statament is inie cnrract anrl cmm�late
County Township
' 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 residen� improve�nts� �
Other Land �1
Total Land
Residential Improvements�;��� � �� j.r3 Dwelling
Garage
�������„Q� Total
Other Improvements AUDITOR
TN�mprovements - Line (6) plus (7) equals (8)
I�(�,,..,dy certify [he^above is true. correct. and complete.
oi
True Cash
Value
(i) �8-mo
(2) —
(3) �. � O O
(4) ��9
(5) _'
Assessed
Valuation
y.��
9,� o
Homestead
Valuation
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- ACTION BY AUDITOR -
A.� � n Date: Z�
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