Homestead_WhittedFOpM MC 10 1979
heuriEeE By Sute BoarE of Tax Commissianers
To & FiIM in Duplicate
CLAIM FOR HOMESTEAD PflOPEflTY TAX CREDIT FOR YEAR 19�c �
SEE BACK FOR FILING INSTRUCTIONS O�9- 0 3 a oa ���
�(We) `�-��-�+� � f e�ned.s�-�---�� certify that on the 1st day of
arch, 19�X_, I, (W�upied as �ur 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 �n
Property Description in � Cnounty �Y'a-f-s-.F� Township
Taxing District (City, Town, Township): `��-��-�-�-��-
Parcel Number or legal description shown on tax statement:
�Y�.r.v�n.�9-e.. �-s.o.o� /2
If buying on contract: Owners name ��� simD�e ow�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: County Township
�
�' hereby certify the above statement is true, correct and complete.
Y ! _//'N".. //n. / i J /T��(i12�/ _ �V v e9. lJf /Mn-�rw�
an0
' Individual either owns or is buyin9 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
2101EQltt/
i �
Land not exceeding 1 on cre irqr�di ly
surrounding resitlential i rovemerft�
Other Land 6L�� � L �rr
Total Land
Residential Improveme� � � �
Other Improvements
�
True Cash Assessed Homestead
Value Valuation Valuation
( � ) /3.s�
(2)
(3) /3sa
�welling (4)
arage (5�
Total �6>
(�)
Tr' Improvements - Line (6) plus (7) equals (8) (8)
I�by certify the above is true. correct. and complete.
Signawre al A#dssor
CJ
Approved:�
- ACTION BY AUDITOR -
S� S�
-��
Date
Date ��,( �,/ -rl7-i'