HomeMy WebLinkAboutHomestead_WallisFOHM HC tU 1979 To Be FileC in Wplicate
RescriOeE By Stzte Board of Tax Commiuioners
CLAIM FOH HOMESTEAO PROPERTY TAX CREDIT FOR YEAR 19�� �
SEE BACK FOR FILING INSTRUCTIONS �!9 � 0 3 0�J3 ' �'�
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,�(We) � � _ 7 certify that on the 1st day of
�iarch, 19�(We) cupied as our principal place residence the following described real property for
which a Homestead Pro erty Tax Credit is hereby being claimed:
I, (We) I� owned
❑ are buying under contract
❑ have a beneficial i�terest in the taxpayer
Property Description in
Taxing District (City, Tox�rr,—Paw�S�fiip):
Parcel Number
If buying Ofl contract: Owners name (�� simple owner�
0
��z� Township
or legal description shown on tax statement:
/1/S S/?/
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:
certify the e t t�
� �� 1 ' ;
is true, correct and complete.
.� / / ti � �a.�� � �
naa.�s
County
'�!'n.-u-
ciry.
Township
�.z2. �> � � �
ana Zio �e
Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficia� interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
Total Land � � � � �
Residential Improvements D II
� u u 1979 "'e in9
_�UN Garage.
^ y/�/�� �I
C�/ / v"`p ¢ti
Other Improvements r
Tr � Improvements - Line (6) lus (7) equ'�� t�R
I�by certify the above is true. correct. and complete.
O� A552SSO! .
True Cash
Value
(�) ioso
(2) —
(3) /OS�
(4)
(s�
(6)
(�) �
(8) S 9'�� o�
- ACTION BY AUDITOR -
Assessed
Valuation
3 J�
Homestead
Valuation
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Date: — 1' � � l�/ � %