HomeMy WebLinkAboutHomestead_Weist (3)warn xc io isn
PrescnEM By Slate Board al iax Commissioners
To & FileE in Ouplicate
CLAIM F HOMESTEAD PROPERTY TAX CHEDIT FOR YEAR 19�� �
� SEE BACK FOR FILING INSTRUCTIONS o�q - 0 3�a9- �o
�(We) '� P��-d Q- �CcJ�!�--� certify that on the 1st day of
March, 19�7 ., 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 -�-�-�-aw County ��-�� Township
Taxing District (City, Town, Township): `i�n.c�.ct��
Parcel Number or legal .description shown on tax statement:
�� 5 E ��� %- a -/ o , /8 .q
If buying on contract: Owners
Coniract 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:
_.�ereby certify the abo4e statement is tru1e, correct and complete.
n
SL
naareu
County
Township
anC Zi0 �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 beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceedin 1( ne) re i� di
surrounding resid�l �ippro�men(3�
�— � ���_
Other Land
7ota� �and JUL 31 1979
Residentiai Improvements Dwelling
� � �����k,� Garaqe
� AUDITOR Total
Other Improvements
T�Improvements - Line (6) plus (7) equals (8)
I'�,,,.oby certity ihe above is true. correct. and complete.
�/767G
True Cash Assessed Homestead
Value Valuation Valuation
(1) /G3o �35�0
(Zl —
(3) /G 3 0
(4) —��
(5) ,Ti
(6) P/io .�
(�) —
(8) 9/i
4�.c-4. ,d.�u.�a. y
Signat ol Assesso� - -
��u•n�:��n.�rr•�:�
Approved: �� ��ce r��-F
�c
L -�1-75
. .oa�e- - - - - — � -
Date: �f- 3�- �j -