HomeMy WebLinkAboutHomestead_Woodruff (3)FOPM HC 10 7979
Preu�iOed By Staie Baard al ia. Commissioners
to Be RIeO in Duplicate
CLAIM FOR HOMESTEAO PROPERTY TAX CRE�IT FOR YEAR 192� /
✓
SEE BACK FOR FILING INSTRUCTIONS O/p,� 033 O p,� �
( "/ 7
�(We) �-�"�e- �. �+-- �' ��� certify that on the 1st day of
��larch, 19�, I, ( ) occupied as o principal place of residen e 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 intere�t in the taxpayer
Property Description in �/.1<-��--a-a-�-i
Taxing District (City, Town, Township):
Parcel Number
If buying on contract Owners name ��ee simpie
or
���"�� Township
description shown on tax statement:
Contract recorded in Recorders Office - Record
%� /8-.l
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 and complete.
�
�
' igna e veet Atltlress C1.u. Scate antl Zip Cotle
' 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 laxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immetliately
surrounding residential � pro�men� �
Other Land �
Total Land
Residential Improvements;t;�,i ? 6 �K �9 Dw�elling
� ��, Gat'age
� , /�.ti���""' Tolal
� AUDITOR
Other Improvements
Tr� Improvements - Line (6) plus (7) equals (8)
l"�by certify the above is true. coyt�ct. and comple�
Signamre oi assessor
Approved
True Cash
Vatue
(7 ) /���D
(2) — o —
(3)
(a)
(s)
(6)
(�)
�re�
i�
Assessed
Valuation
,�
_�,
Homestead
Valuation
C•�
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6-��-�g
_ Dare
Date:----1�i����—