Homestead_Vanvliet (3)FOHM HC /0 1979
P!lYlibEd BY $(dl! BOdlO 0� TdS CORIfI115510f1l15
CLAIM FOR HOMESTEAO PROPERTY TAX CAEDIT FOR YEAR 192�
To & FIM in U:plicate
I
SEE BACK FOR FILING INSTRUCTIONS • Q�9.� O 3 �l7 �� �
�(We)� -N�% ��� �1�r� �!a'1M�e�— certify that on the 1st day of
arch, 19�, I, (We) occupied as our principal pla�esidence 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 int est in the taxpayer
Property Description in���� County �a�� Township
Taxing District (City, Tewa--�ewm'PTTp): �� .
Parcel Number
If buying on contract: Owners name ��� simo�e
or legal description shown on tax statement:
G �_ � � -
Contract recorded in Recorders Office - Record
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
hereby certify the
S°�,.;�G�-,�
'Signature
statement is true, correct and complete.
�
Shret
Township
Ciry. State and Zip CoOe
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
�d
True Cash Assessed Homestead
Value Valuation Valuation
(�) �.��o �a 70
(2) —
(3) . �� o 0
.
'`D%/O%%%�//00%
/./%�%//O%�/O
.
� � i r � .
.
� V
� '�/� 7�
- Dare — - ' -- ' ---
Date: