HomeMy WebLinkAboutHomestead_Westerfield (4)FOFM HC 10 1979
Presni�ea By State Boara ot Tax Commissioners
io Be Fil¢0 in Dupliwie
CLAIM FOR HOMESTEAO PROPERTY TAX CREOIT FOR YEAR 19�� �
SEE BACK FOR FILING INSTRUCTIONS O�Q— �3��pS`��
�(We) ��-` ��-�- � W-e-a.in�C.-��i certify that on 4he 1st day of
�arch, 19_��, I, (We) occu ed as our princip place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:. �
I, (We) GYnwned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in �An) County `'P� Township
Taxing District (City, Town, Township): `��1n«���^-^� Q%>±M!-�% /O
Farcel Number or legal description shown on tax statement:
, 9� 0. b �' 1 e 9 Oc� ��
If buying on contract: Owners name "� �""o'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 coun[ies in which individual owns or is buying real property: County Township
;hereby certify the above statement is true, correct and complete.
C' �
. , 'd^3
ignamr Sveec Aaamss . y. Sia;e ana Zio 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 beneficia� interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1�o e) �cre F�ned�ely�
surrounding residential improvements
Other Land ��L � 0�979
Total Land
Residentiai Improvemenls�i r ���Welling
� �� AUDITt7�
arage
Total
Other Improvements
To+ � Improvements - Line (6) plus (7) equals. (8)
���by certity the above is true. correct. and complete.
O� A55¢SSOr
True Cash
Value
(1) /8 S�o
(2)
(3)
�a�
(s)
(s)
(�)
($)
- ACTION BY AUDITOR -
Assessed
Valuation
�o �n
�ia
S- lP-�9
oa��
�
Homestead
Valuation
Approved: �z �� Date: � °��" �