HomeMy WebLinkAboutHomestead_WebsterFOBM HC 10 7979 To & FiIM in DuDlicate
PrescriDeO By Sute BoarO af Tax Commiuioners I
CLAIM FOR HOMESTEAU PROPERTY TAX CAEDIT FOA YEAR 19 �� �
SEE BACK FOR FILING INSTRUCTIONS O/ q- �3SS6-o �
��� C�//%�_e�d.7,e.�� � C!'. �• d !//c�.—oY.
(We) certify that on the 1st day of
� arch, 19 % I, IWPI n�r_.uniP�1 as �u �rinri�al � ar_.P nf fP_.$jAP_.f1QP_. 1F1P_. fnllnwing described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) �wned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property DescYiption in 1�k�-a-n-- County
Taxing District (�ii�c�Se�fr-Township):
Township
Parcel Number or legal description shown on tax statement:
�. ''5��� /8�Z - io � ��/�)
If buying on contract: Owners name �'� HmD�e
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:
certify the �bove statement is true, correct and complete
County Township
� ���/ �7�70
Sign re // Stree� AdOress Ciry. State and Zi0 �e
' Ind����her 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 imp t
Other Land � � � --
Total Land
Resitlential Improvements JUN 251979 Dwelling
�����uu2���ge
AUDITO �
�
Other Improvemenls � Sho�
T��` '�'mprovements - Line (6) plus (7) equals (8)
I>�.,y certify the above is true., correct. and complete.
Signawre o� Azsnsor
Appraved
True Cash
Value
(�) /3�0
(2)
(3) /��o
(4) % b'Sa
�5� a—
�s� .7 � So
(7) b' `�a
(8) � � �J O
- ACTION BY AUDITOR -
Assessed
Valuation
y�o
��d
Homestead
Valuation
� S� o
� �
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G-��-7
Oa:e
Date: 7