Homestead_Wilkinson (2)FOfiM HC 10 1479
PrescriDM By Sute BaarE af Ta. Commiuioners
To & FiIW in Dupliwte �,
CLAIM FOR HOMESTEAD PHOPERTY TAX CREDIT FOR YEAH 19 �% J
SEE BACK FOR FILING INSTRUCTIONS o�q- o3a y� -��
��(We) w�"r-'� v�—�-a-�- �• certify that on the 1st day of
arch, 19� I, (We) occupied as ou p' lace 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 jntgrest in the taxpayer
Property Description
Taxing District (City,-�ewa- Tewnsbip): 7--�-�—
Parcel Number
If buying Ofl contract: Owners name ��� simv�e ownep
_County �/ � Township
or legal description shown on tax statement: .
���r� � i d 9 �.�r-
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:
_�hereby certify the above statement is true,.correct and complete.
� ,. � .n, �.-, .� ,
County
a�r.
Township
ane Zip CoCe
' 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 L� � � � _
Total L
Residential Improveme�� ,�979
JUPJ -
Total
Other Im� nCs
�oiToR
Tr Improve enls - Line p us (7) equals (8)
I�by certify ihe, above is�true. correct. and complete.
True Cash Assessed Homestead
Value Valuation Valuation
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