HomeMy WebLinkAboutHomestead_Wade (3)FOftM HC 10 19i9
hescri�eU By State Boam of Ta. Commissioners
To Be Filetl in DuD�icate
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT FOR YEAR 19_7�� �
SEE BACK FOR FILING INSTRUCTIONS Q�C,-03OLfa`o�
� (We) I�ir/T�a.�:�� ` ,��,�,-�J 4� , a
�narch, 19_�,'��, I, (We) occupied as o principal place oi
which a Homestead Property Tax Credit is hereby being
I, (We) ❑ owned
❑ are buying under contract •
❑ have a beneficial i erest in the taxpayer
Property Description in �� � Cou
Taxing District (City, T-ewr�Fewftship):__i��°'
�� certify that on the 1st day of
the following described real property for
_ ��t� Township
Parcel Number or legal description shown on tax statement:
'v���.- �6� � 9
It buying on contract:.Owners name �'� 51np1e °"ne'�
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:
�hereby certify the above statement is true, correct and complete.
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,.e.,�«..F. �,c�,�:� - �l7ai •.. G�..�'! �lo� �%� � � -- G!i'�r� '�
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County
�
Township
n
S:ate ana Lo Cotle
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
True Cash
Value
(�) �/oo
(2)
��
Assessed
Valuation
—�� ��1
Homestead
Valuation
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Date: C!!�NC_/__! �
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