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NescrihM By Sute BoarG ol Tax CommiSSioners
CLAIM FOA HOMESTEAU PROPERTY TAX CHEUIT FOH YEAR 19 79
To & FileE in Dupliwte
/
SEE BACK FOR FILING INSTRUCTIONS p�q_ o3aqs� o0
�(We) ���� a- �-�-L�� certify that on the 1st day of
. arch, 19�g., 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) C�'owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in � ' n County `��� Township
Taxing District (City, Town, Township): `T'�-�tt.r'1-r.�.., Q�n� l�
Parcel Number or legal description shown on tax statement:
`�%:�, , �'a.a.� /S/ 7
If buying Ofl contract: Owners name ��� simoie owner�
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
� hereby certify the above statement is true, correct nd completej
� �O a, �
�� � � � ��76 �d
/'Si re Sveet ACCress Gity. State anG ZiD �e
L
' 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
Total L� n
Residen I Improve�ts�
MAY 2 'i 1979
Dwelling
Garage
Total
Other Impr me s /�/�4�,�j
To� ' Im e (s - ine ��� (7) equals (8)
I.�oy certif the above �s true. correct. and complete.
o� ASSe550I
Approved:—�
True Cash Assessed Homestead
Value Valuation Valuation
(i) . cL�F�o
(2� 3 3 0
(3)
�4)
(5)
(s)
(�)
(8)
- ACTION BY AUDITOR -
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Date: SL� 79