HomeMy WebLinkAboutHomestead_Summers (5)ww.+ xc �o �s�v
ReuribeE By State BwrE ol Tax tommiuioners
To & Fi1M in DuDliwte
CLAIM FOA HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19%/,� ✓
_ SEE-BACK FOR FILING INSTRUCTIONS Q(�- Oag�3' pQ
'We - �- certify that on the tst day of
a�c , 19 I, (We) occupied as ur principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
O are buying under contract
❑ have a beneficial erest in the taxpayer ,/�.,�—�
Property Description in �,�� County ,i"'u�-a��t � Township
Taxing District (City, Tsa�nfTswa�sbip): �
,� �
Parcel Number or legal description shown on tax statement:
l���c?y�� � i�� ,/ 7 D
If buying on contract: Owners name �'� �'"'v'e °w"ef�
Contract recorded in Recorders Office - Record No
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: County Township
�ereby certify the above statement is true, correct and complete.
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Ciry. S�uf ana Zio �o0e
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 impra�eemer�ts � �
Other Land �� d �
Total Land
Residential Improvements
Other Improvements
���� � � �97�-Dwelling
� .� �.
� � `,
�
�•
True Cash
Value
ci> /5� 9 a
(2)
(3)
(4)
(5)
(6)
(�)
To',�'mprovements - Line (6) plus (7) equals (8) (8)
I t�y f,er�iiy the above is true. correct. and complete.
Signa:ure oi
Assessed
Valuation
�o 0
/ 5� q o S'o 0
J�
Homestead
Valuation
- ACTION BY AUDITOR -
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Date �
Approved: /��1. �-�-�-� � Date: �P=�%7 y