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CLA1��1 FOR Ha��STEAD PROP�TY TAX C�IT FOP, YEAR 19� ,/
SEE BACK FOR FILING INS7RUCTIONS O�q'D3�OS'�'a
I�•. ,��) �yJ� �� , o Q //�� ��'u.j�n, _ oest.ify that on th= lst day o
�r-ch, 19�, I, (P7°) occ�mis3 as princioal Place oi residence the follaaing descsib�d real
T ooPsty for which a Hmr�t�d Pmperty Tax Credit is h=reby being claix�:
I, (i�=) � ocane3
� aze buyinc? under �ntract
� have a be�eficial interest in the ta�mayer
Pro�rty Des: rip`ion. in /�c%7t �/
Tav.ing District i+ � Toc:�n, Zbwnshio) : T
Pzrel iliunb-.s or le�al descrintion shoo.� on tax stater�..nt:
�<<�� 7� ���.: �-� ��
Z'�n,TJY1.1
I' bu�.�ir.a om m�;sact: Ow-ners n3n'e (=e� siir�le crvrn:s)
- - Co;a�ract rerord�3 in P°a�rder'S 0=iice - Fecord No. Page
Z` any mr,ion of '-,he residential ssucture or `he land, not er�-e�iing or.e (1) acre that
irrr.�iiacely suLZOw-ds tha` structun_ is used tn prociuce incane, describe th= use a�ri oortien of
tne oropAxty utilized to omduc= ir�orre
pn:�, o`s'-°* m�ties in which individ�l aans or is bv�ing rAal nmo�._rty:
her�y
anove stata�nt is true, mrrect a� cor�lete.
.�' -� � _ ,Ps � �L `%1'1 cu�.,��.- .� .
CotmtV �.tirshio
*Individaal eith°r a,-ns or is buying imer a mntract that provid�s he is tn nay �he
piplpSL}� t.dXS on �:n° residence, or has a be�_Licial interest in the tavpayer.
- FOR ASSESSC?R�S USE ONLY -
Land not ex��?in9 1(one) acre i�diately
sisroun3ing resi:denfial� itr�nroverents
Qt:ner I.and � � � `� �
T°� � (v1AR 1980
P�sidential Inprovements Dc,elling
° "d �°`nz� Garaae
AUDITOR
Zbtal
True Cash
Valu_
. fl) 30.�0
(2)
(3)
(4) '
(5)
(6) 313So
o�-,h�r I�rwsn�.�,ts c�> _
Tc ' Ir,c»rweirn�ts - Lins (6) plus (7) ec?uals (8) (8) _
�'r.er�� c�sti"r}' th° a1�e''-' is tn:e. corre�� a� o�rolete.
Si�at��=_ o* rssasor
- ACTIOt� ?Y 4UDITnR -
Pssess�3
Ve1 uation
�l//0
�����
P�t�
P.�rovw: �/� l/LU .�s�— _ Dat=: %n v�-. `�- /48�
I la�s �_„
Valuatio:
/oLo
�o �/So
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