Homestead_Ward (5)WPM NC 10 1W9
Prt5di0e0 By State Bw�O of ia. Cammissioners
To Be PileE in Duolka;e
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19� �
SEE BACK FOR FILING INSTRUCTIONS p/q _ p3 o Sy• �O
�(We) certify that on the 1st day of
�arch, 19�, I, We) occupied as our ncipal place of residence the following described real property tor
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) C3�owned
❑ are buying under contract
_ ❑ have a beneficial intere�s/t in, the taxpayer �/�
Property Description in �-�-�^-� nCounty `�"'Q�.a�.a-� Township
Taxing District (City, Town, Township): `-/'�/ttix.c�-GV�� �xix.c.i,c�
Parcel Number � or legal description shown on tax statement:
�n�e-�C�c.c..z� '7 /A
.
If buying on contract: Owners name �'� 5irtip1e °""ef�
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:
hereby certify the above statement is true, correct and complete
:�
sueet Aaoress
County
Township
Gty. State ana zip Cpop
' 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 -
True Cash
� � ( � � Value
Land not exceeding 7(one) a e im ediaE�y •
surrounding resideniial improvements (�) /�ao
Other Land
Total Land
Residential Improvements
Other Improvements
,:',;N 71979
(/j" � /�rA.�i�'�'=e�
Ae��
Total
(2)
(3) 7 `���
(4)
(5)
�6,
(�)
To� � Improvements - Line (6) plus (7) equals (8) (a)
I�by certify the above is true. correct. and complete.
Assesso�
Assessed
Valuation
Homesiead
Valuation
9�
- ACTION BY AUDITOR -
�s['�s�
�
0 r,
Approved:� � �• � � Date: —