HomeMy WebLinkAboutHomestead_WashburnFOflM HC 10 1979
Prescribetl By State BwrO ot ia. Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19��
io Be FileU in Duplicate
✓
SEE BACK FOR FILING INSTRUCTIONS Q�9'— O3Oq%- OD
f�'(We) �G� <Z�� �� c�� (-� �� �/'� certify that on the 1 st day of
March, 19 I, (We) occupied as our princ a place�of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial int�rest in the taxpayer
Property Description
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name ��� simo�e
_ �� d� Township
or legal description shown on tax statement:
,, '��.,�1�o-�'s ��, /
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.
County Township
�i+-,-.-t '�is Z�is..-C/ a� %7 iS cc/g-�C �.. �,. aw . .n�+-•-�c.-L -. - Y 1G �c�
'Signawre ' Sveet AtlCress Ciry. Sta�e ana Zip Coae
' 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 residential improvements
Other Land � ����
Total Land +
Residential Improvements
I�"A.E 5 ? 1983
� . � . CA�t���
Other.�lmprovementsp'UDITOR
Dwelling
Garage
Total
-� Improvements - Line (6) plus (7) equals (8)
I eby certi(y the above is true. correct: and complele.
Siqnawre of Pssessor
True Cash
Value
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(3) _ <�--�
(4) ����- c� �
�s� —
Assessed
Valuation
�/�
�. / D
Homestead
Valuation
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- ACTION BY AUDITOR -
5�/3i ��3
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Approved: Date: