HomeMy WebLinkAboutHomestead_UlishneyFORM HL 70 7979
Fcscri6e0 By Sute BoarE of Tax Commiuioners
CLAIM FOR HOMESTEAD PROPERTY TAX CflE01T fOR YEAR 19 � v
To & FiIM in Duplicate
�
SEE BACK FOR FILING INSTRUCTIONS �� q- o a g g��Q O
'Go hn,�
�(We) '��R2y �' �� K �� �S�'�� certify that on the tst day of
rch, 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) � owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer /!n
Property Description in ���SOiJ Count ��! °�'9 Township
Taxing District (City, Town, Township): .2��✓ceio..�
Parcel Number or legal description shown on tax statement:
P� r/w'r.� /�-a-io . � �{ A-�
If buying on contract: Owners name ��re simple
Contract recorded in Recorders Office - Record No. Page
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:
ereby certify the above statement is true, correct and complete.
0 / .
:-.% � , lJ .� r.. _ r-� ,� �
noaress
County Township
C�ry. Siare a�a zip Coae ;y ��.� p
' 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 exceedi�l �ne�r�rr�fely
surrounding residential improvements
Other �and qpt� 21 i��2
Total Land (�
R e s i d e n t i a l I m p re�einent�T'•.a�skt►��.�!
(,� ��ITOR Dwelling
Garage
Total
Other Improvements
To !mprovements
I :iy certify the
$ifJO u A552550I
Approved:�
Line (6) plus (7) equals-(8)
�ov,�is, true. correct. and complete.
�
True Cash
Value
��� /000
(2)
�3� / a o
(4) �� °
(5)
�g) .20 � o
c>> I�b '
(g) c2 !
- ACTION BY AUDITOR -
Assessed
Valuation
330
33�
Homestead
Valuation
330
� y�-P v
Oare
Date: �� � � ' ��--