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To & FileO in Dupliwte
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOH YEAR 19�� �
(1, �'C� SEE BACK FOR FILING INSTRUCTIONS o��- oa8r�-oo
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�(We) �-�-�-Q-���--+� ��'��'�1 certify that on the tst day of
vlarch, 19��, 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) fe�owned
❑ are buying under contract
❑ have a beneficial inte,rJest 'in the taxpayer
Property Description in _�-�d.-�.+ ' nCounty �Q �� Township
Taxing District (City, Town, Township): `��� t-�-�� Q���[. �
Parcel Number or legal description shown on tax statement:
� f�E. N w'�f l 7-Z i o ,.i—/ R
If buying on contract:. Owners name ��� ��"o�e �.�e,�
Contract recorded in Recorders Office - Record
If any portion of the residential structure or the land, not exceeding one (t) 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 buyin9 real property: County Township
�hereby certify the above statement is true, correct and complete.
n . _ �l% � .,. • � � .-� p n . � ..-R /f
Sveet
City. State an0 Zip CoGe
' 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 improvements
Other Land � � � � �
Total Land
Residential Improvements
'UN ? 2 1979
Dwelling
Garage
�% /����� Total
Other Improvements ' ' '
T,^ ' improvements - L ne (6) plus (�}��b�� (8)
I�by certify the above is true. correct. and complete.
/+55¢SSOr
True Cash
Value
(t) �000
(2) —
(3) l000
(4)
(5)
(6)
(7)
(8)
Assessed
Valuation
330
33a
0
Homestead
Valuation
- ACTION BY AUDITOR -
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Date: G —� 7= � �_—