HomeMy WebLinkAboutHomestead_Whitten (7)FOiiM HC 10 1979
PrescriGeO By State BoarE of Tax Commissioners
io & FileE in Wplicate
CLAIM FOA HOMESTEAD PROPERTY TAX CREDIT FOH YEAR 19�2 �
SEE BACK FOR FILING INSTRUCTIONS Q(C! — Q 3 a � jo ' Q O
��yye� qo•�,_ F', ��,�„� p•�o�S N• certify that on the 1st day of
arch, ?� I, (We) occupied as our principal place ot 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 �(L�.lyd.n� County Y%'��� Township
Taxing District (City, Town, Township): ���
Parcel Number or legal description shown on tax statement:
l.sJ c-o-�� � ��
If buying on contract: Owners name �'� �""ae °""ef�
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
certify the above statement is true, correct and complete.
�� ' Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneticial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
F
,_; True Cash
€'r� Value
Land not exceeding 1(one) acre immediately
surrounding residential improvements (�) /SS'o
Other Land
Total Land
Residential Improvements
Dwelling
Garage
Total
Other Improvements
Tr� Improvements - Line (6) plus (7) equals (8)
I 1f�by certity ihe above is true. correct, and complete.
Asse550!
APP
(2) �'
(3) /.�Z
(4)
(5)
(6)
(�)
(8)
Assessed Homestead
Valuation Valuation
r
- ACTION BY AUDITOR -
l�-aa-�s
Date
Date: ��