HomeMy WebLinkAboutHomestead_WaldenFORM HC 10 1979
PrescriUed By S�a�e Board ol ia, Cammissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT fOR YEAR 19 '�9
To & Filea in DuO�icate
�
SEE BACK FOR FILING INSTRUCTIONS O�9 � O;3 r(�' OO
, '
��(We) � certify that on the 1st day of
rch, 19�, I, (We) occu ed as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) B'owned
❑ are buying under contract
❑ have a beneficial in,t,e/res�t in the taxpayer
Property Description in ,�--v-d-n+..� County ��Q- Township
Taxing District (City, Town, Township): `%'�1-�-�..- �.v�.�r / o �
Parcel Number or legal description shown on tax statement:
�l P.� /, z 5.�._.Q. 0. ;� - fi'/ -R�r
If buying on contract: Owners name ��� simo�e ow�e,�
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 Township
I hereby certify the above statement is true, correct and complete.
�
' 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 resitlential improvements
Other Land � � � � �
Total Land
Residential Improvements Dwelling
i;!+�! `' y i979
_ Garage
� ����-�d��VOtal
Other Improvements �
Total Im rovements - Lin�lus 7 �� 8
P O P (l� R)
i(�:by certify the above is true. correct. and complete.
NSSPS50l
True Cash
Value
(>> �s�—
(2) —
(3) aS 90
(4)
�s�
(6)
(�)
(8)
,
Assessed Homestead
Valuation Valuation
__ �_C- G
' � -
�����������
jjj/��j�j/
, ,,,,,,,,,,,,,,,,,,,,,,,,,
��jj�jjj
�j�jj�
� S-i7-�
��� -
- ACTION BY AUDITOR -
/ l
��7 Date: _C!-�Z 2- - �7`,
�