Homestead_Wilhite (5)FOFM HC t0 t979 7o Be Filed in DuOficate
PreuriEea By S�ate BoarO ol ia+ CAmmissfaners
CLAIM FOR HOMESTEAO PROPERTY TAX CREDIT FOR YEAR 19�� ✓
SEE BACK FOR FILING INSTRUCTIONS p�q_ o3aaq` �Q
�(We)� '�- ��G���tJ •`� �' f'�--� �- certify that on the 1st day of
arch, 19 7! , I, (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� owned
❑ are buying under contract
❑ have a beneficial inte,rest in the taxpayer
Property Description
Taxing District (City, -Iewa-�sF}ip'j: � � �-�-� �
Parcel Number
If buying on contrect: Owners name �'� 51np1e °'""e`�
�� Township
or legal description shown on tax statement:
� /�l Q. . � 0 9
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
s[ructure 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:
reby certify the above statement is true.. correct and complete
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County Township
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Giv. S:a�e ana Zio Caae
' Individual either owns or is buying 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
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
True Cash
Value
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(2) — —
Total Land � � � � � (3) � � U
1�
Assessed
Valuation
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— o --
Homestead
Valuation
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Date
Date: �.�_9 �-rj'