HomeMy WebLinkAboutHomestead_TyreeFOflM MC 10 1979 io Be Filea in Uuplicate
P�escribe0 By Stale Boara ot 7a. Commissioners
CLAIM fOR HOMESTEA��PROPERTY TAX CREUIT FOR YEAR 19 7 9 ,�
�S �ACK FOR FILING INSTRUCTIONS Q��� Qaq%�p-O�
�(We) `E ' certify that on the tst day of
arch, 19 79 , I, (We) occu ied s our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a benefici�a��l c��inJje�res�t in the taxpayer
Property Description irx�
— �
Taxing District (City, ,
Parcel Number
i
�-�-e� Township
or legal description shown on tax statement:
�p�.o...�_� � � a n�z
If buying Ofl contract Owners name ��� simole owneq
Contract recorded in Recorders Office - Record No. Paoe
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.
� � • � .�,,, h
County Township
'Signature� L �/ SI� AO�ress "' � Gry. S;a�e ana Zip Coae
V . � d / / � � �
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 i�v� � � �
Other Land
Total Land
Residentiai Improvements .;iJ"! 2. i979 D II
Other improvements
�-T- �Improvements
i�fe�B,y certify the
Ap
m
we ing
/% �/���t�� ��rage
���� ta i
� AUDITOR
- Line (6) plus (7) equals (8)
above }s _true. correct. and complete.
True Cash
Value
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(2) °
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(5) \ / O
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Assessed
Valuation
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6>a
Homesiead
Valuation
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Date: �