HomeMy WebLinkAboutHomestead_WehmerFOftM HC lU 1979
Prescri�eG By State Baa�O ol 7a. Commissioners
io B¢ Filed in Wplicdte
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19� �/
SEE BACK FOR -FILING INSTRUCTIONS Q/G� _ p3�a3� �Q
��(We)� �u `7.J��*_.A certify that on the 1st day of
arch, 19�, I, (We) occupied as our principal 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 interest in the taxpayer
Property Description in � County �� Township
Taxing District`(City, Town, Township): `�t.c.,ti.c-a-LZti�-
Parcel Number or legal descripiion shown on tax statement:
�-�5'/a_ (� - � -� o , u A
If buying on contrect: Owners name ��� simo�e
Contract recorded in Recorders Office - Record
If any portion oi 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
x�a
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 i�ove�ents� � �
Other Land
Total Land
Residential Improvements
Other Improvements
. Jy ;. J �91�
� Dwelling
�i�
[��rage
/��' ti'
Total
aUDiTOR
�, �
��
True Cash
Value
(�) Gl�o
(2) —
(3) loGo
(4)
�5,
(6)
(�)
T ' ' Improvements - Line (6) plus (7) equals (8) (8)
I�by certify the above is true. correct, and complete.
Qn .r J.t. �i .��
Siqnamre nssessor
���
- ACTION BY AUDITOR -
Assessed
Valuation
2 �o
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Homestead
Valuation
i� -aa-�9
Date
Date: G- �S Z9