Homestead_Wallace�rescribed. By State &nrd of Tax Cac[missioners
CLAlh1 FOR HON�STEAD PROPERTY TAX CRmIT FOR YEAR 19 ��`� '� �
SEE BACK FOR FILING INSTRUCTIONS ��L,- Q 3 �(p (/- 00
I'�.��e� ��.� ,�.�iw,��. �/'d-�-�-�-^^^ /�" certify that on the lst day of
h, 19 y, I, (PTe) occ�ied as pnncioal olace of r idence the following described real
;�erty for which a Hwnestead Property Tax Credit is hereby being clai�:
i , 6•7e ) �'ne3
� are buyinq under wntract
� have a.beneficial intere t in the taxnayer..
Prooert�• Description in �r-� ��tY
Taxing District (City, Ta•m, 4bwnship):
��� .
nxanship
p3rCe1 Pl�s or legal description shown on tax statarnsit:
` Q� ,5 W��� 7-Z - i o .�- S'
�'Et,� `f�'��
I: buvina on o�ntract: OwnPSS name (fee simole ormer)
Contract recorded in ���c3er's Office - Recnrd No. Page
If any portion of the residential structizre or the land, not e�eeding one (1) a¢e that
i�iately surroim3s that structure is used ta praluce incane, describe the use ar,d partion of
�° ProPertY utilized to produce income
Any other c�unties in which individual aans or is buying real property: ' Co�
T_�SPl]�' CPS"t/�
�
is true, �rrect ard co�lete.
`1t7v771StLLA
��
*Individual either aans or is buying tmer a wntract that provides he is to pay the
property.taxPS on the_residence, or has a benefieial interest in the ta�yer.
. - FOR ASSESSOR�S USE ONLY -
True Cash
Vali�
Land not exceeding 1(one) acre inmediately
surrowrling residential i�rovpments (1) a 3�'o
0'-�her Larui
Total Land
P,esidential 7lmrov�re.nts
orns �rrn,a„ents
`PO �: I�rov�nents - Line (6)
I h�seby certj,fy� is
S�� ��1
3ture of Assessor
�
(2) —
(3) ,� � �a
�'�
Dwelling (4) � ��
Assessed
Valuation
9g�
_ �
��������
/���/
. -.- ����//
'i_ . .
._. , .
._ __.
/////%///%%��
>. . : � � �������
_ . _ _ . .. � - -
• •
-� /
�, -
ikmestead
Valuation
% 90
- ACTION BY QUDITnR -
ADe*vved: Date: