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HescriDeE By State BoarG ol Taa Commissioners
To & FileA in DuDlicate
�.Z�p`�AIM FOR HOMESTEAD PAOPEATY TAX CREUIT FOR YEAfl 19�� ✓
SEE BACK FOR FILING INSTRUCTIONS Q(L�_ D 3/33- o 0
/ ��/ .
�(We) ��7��-�--L �� �' �
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): `�ir.c�xwC"e,-..
Parcel Number or legal description shown on tax statement:
/3 � 5���.
._�o-t<rt.� �%1.'� /3.�
If buying Ofl contract: Owners name ��� simoie owner�
Contract recorded in Recorders Office - Record N
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
office in home -- room si�.P: 8 ft. x 15 f+_
Any other counties in which individual owns or is buying real property: County Township
�hereby certify the above statement is true, correct and complete
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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
JUN ? i� i979
Dwelling
Garage
/L�i4� Total
Other Impravements �� ` AUDITOR
i
T'' Improvements - Line (6) plus (7) equals (8)
I�by certify the above is true. correct. and complete.
Q��.l� ,{�.s..�c�,.,�
SignaWr 1 Assessor
Approv
True Cash
Value
(il .30�0
(2) �
(3) 3OPo
(4)
(5)
(6)
(�)
(8)
- ACTION BY AUDITOR -
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Assessed Homestead
Valuation Valuation
/030
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Date: