HomeMy WebLinkAboutHomestead_Terry (3)FOflM HC 10 7479
ReuriEeE By State.Bwrd of Tae Commissioners
To & iilM in Ouplicate
CLAIM FOA HOMESTEAD PAOPERTY TAX CREUIT FOR YEAA 19 � 9 �
n SEE BACK FOR FILING INSTRUCTIONS . Oi�- Oo� gS9' O�
,(We) � � �' certify that on the 1st day of
�Aarch, 19Z�, I, ( ) Occ ied as ur principal p ace f residence the following described real property for
which a Homestead Prop Tax Credit is hereby being claimed: ,
I, (We) �owned
LC] are buying under contract
❑ have a beneficial iQte,rest,jn the taxpayer
Property Description
Taxing District (City, Tewrt�wrtship): �_�
Parcel Number
If buying on contract: Owners
\ � Township
or iegal descrjption sho� on tax statement:
� ����ll a � �
Contract recorded in Recorders Otfice = Record No. Page
t
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 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
True Cash
Value
c>> �' o--�
(2) — ° —
(3) �
Residential Improvements Dwelling (4� � �
� � � Tot��s> � � `
Other Improvements (�) —' —3
��.prnr 191� �
T�' ' Improvements - Line (6) plus (7) equals-(8) (8) o� �!�
I�{�y certify the above i� true. correct. and� c�mplete.n
Assessor
- AC;1'I�fV'BY AUDITOR -
Approved: /����L�o.�!��
T
Assessed Homestead
Valuation Valuation
a 7u �Z7o
�- a �-�9
Daie
Date: /� +Z�` �% �%