HomeMy WebLinkAboutHomestead_Wick (3)FOflM HL 10 1979
HcscriGeE By State BwrC af Tax Commissioncrs
To Be Filed in OuD����e
CLAIM FOR HOMESTEAD PAOPEATY TAX CREDIT FOA YEAR 19�� �/
�SI_,,\I � - SEE BACK FOR FILING INSTRUCTIONS D�9- o3a4 �-�o
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�(We) ���-1- �%�'� certify that on the 1st day of
�arch, 19��L, ,(We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) C3'owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer , n
Property Description in �� County �`�� Township
Taxing District (City, Town, Township): �/t-tn+,c'!.�-ew Q�x�r.-c;� /°
Parcel Number or legal description shown on tax statement:
.. . - ),_Q<.�� �.,�� n a, y�.C� _ k� ���o� ��
If buying Ofl contract: Ow�ers name ��� simple owner�
Contract recorded in Recorders Office - Record No. � Page
If any portion of the residential structure or the land, no£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:
hereby _certify the above statemeQt is true, correct and
AOOress
lete.
County
Township
��
ano 2io Wee
� ✓ ` Individual either owns or is buying under a contract that provides he is to pay the property taxes
�� on the r sidence, or has a beneficiat interest in the taxpayer.
� �� �n�� - FOR ASSESSOR'S USE ONLY -
._ � � `�\ \ 1 •n, �
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L.ti �`��2a� � �
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land �� � � � g {�
Total Land �'d�
Residential Improvements J�i� � 7 i979 Owelling
�� Garage
( . 'j�, ���u,Z�Total
Other Improvements %% AUDI70R
Tn� i Improvements - Line (6) plus (7) equals (8)
I�by certify the above is true. correct. and complete.
ot Assessor
True Cash
Value
(�) Sa7�
(z) �
(3) 5� '7 �
(4) _ —/pS�/ o
(5) �
(6) ��0 �
(�)
(8)
7�i
Assessed Homestead
Valuation Valuation
l6 90
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5 —/1 -7y
oa:e
Date� 7