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FOflM MC 10 79i9
Pre5ui0¢0 By State Baara al ia. Commissioners
To Be File� in Dupli[a�e
_ CLAIM FOR HOMESTEAU PROPERTY TAX CREUIT FOR YEAR 19 8� �
SEE BACK FOR FILING INSTRUCTIONS Q�9- D3OSS'�
�(We) ���-�-�-� 7�6��� r°`�-�Q^"�- certify that on the 1st day of
�.iarch, 19�v I, (We) occupie as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owne�
� are buying under contract
O have a beneficial interest in the taxpayer
Property Description in /
Taxing District (' y Town, Township):
Parcel Number
If buying on contract: Owners
y �� Township
or legal description shown on tax statement:
Contract recorded in Recorders Office - Record No. `�� Page d�� 7
If any portion of the residen[ial 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
� `2e>�.�, � a� �-zJ. �
�'Signamre Street AEOress
County Township
Clry. Sia;e anC i0 �e ' /�.,�`�
%/ �
' Individual either owns or is buying under a coniract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
{yq ���-�O ASSESSOR'S USE ONLY -
.g.
MAR 16 1982 > True cash
Value
Land not exceeding 1( ) immedi el
surrounding residential dr�e (i) / 9 cio
AUDITO
Other Land (2) - '—
Total Land (3) � 9 ��
Residential Improvements
Dwelling
Garage
Total
Other Improvements
TM^� Improvements - Line (6) plus (7) equals (8)
I�by certify the above is true. correct. and complete.
Sig(urore o� nssesso�
0
(4)
(5)
(6)
(�)
(8)
Assessed
Valuation
la �a0
��o
Homestead
Valuation
�n�o
- ACTION BY AUDITOR -
.
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�1� �98z
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Date: �I �-c.. /6� (98aZ