Homestead_WoodburnFORM HC 10 19i9
Prescri�ed By Sia:e Bw�O oi Ta+ Commi55ioneR
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT FOR YEAR 19 ?`L
7a Be FileG in Duplitaie
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SEE BACK FOR FILING INSTRUCTIONS �/A _�3 3 �� _ O O
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�(We) �"'P�� �' � �'e'L`"�'«'-' � �`�ertify that on the 1st day of
� arch, 1911, 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) �wned
❑ are buying under contract
❑ have a beneficial interes,t� in the ta�xpay�er
Property Description in �^d-�O'r`--� Courlty , �� Township
Taxing District (City, Town, Township): �
Parcel Number or legal description shown on tax statement:
O.,t �,� % '7 -e2 - /o , � o /3ce.�
If buying on contract: Owners name ��� simo�e ow�e��
Contract recorded in Recorders Office - Record No. Page
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.
Sveei naaress
County Township
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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.
ASSESSOR'S USE ONLY -
True Cash Assessed Homestead
Value Valuation Valuation
Land not exceeding 1(one) acre immediately
surrounding residential impr m�jts � .(�) ��%�
Other Land � t7 � � � �z) —�
Total Land (3) 3 � 90
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Date: —�g