HomeMy WebLinkAboutHomestead_RumbleCLAIM FOR tU''ESM PROPERTY TAX MIT FOR YEAR 19_
SEE BACK FOR FILING INS,.TR IONS
0402 _ Q Q�SI�, 00
aAZ_ —we e certify that on the 1st day of
perch, 29 I, (We) or-CLIP
as our pnx=bzd place of residence the follaaing described real
rnop..rty for which a Hong stead property Tax Credit is hereby being clam:
j (we)
are buying -under contract
have _a beneficial ?b %fitey�
ounty T
Property Des.�-riptico in C uF
Taxing District (City, Tv+m, Township) :
Parcel ihmbar I or legal description shown on tax statement:
_5F_ '/9C NE '/s' 6 8 . -, - -,�° /, I e
If buying on contract: Owners name (fee si1le owner)
Contract recorded in Pecorder's Office - Record No. Page
If any portion of the residential structure or the land, not ecoeeding one (1) acre that
irmeciiately surrounds that structure is used to promice intone, describe the use aryl portion of
the property utilized to produce incom
Any other counties in which individual vans or is buying real property: County Tcwns ip
I hereby certify the above statement is true, correct and =wlete.
f-13Z
*Individual either owns or is buying uner 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 inoiediately
surrounding residential improvements
Other Land
Total Land
Presidential Inprovenen }s
True Cash.
ValL_
(2)
(3)
DdeMing (4)
Assessed
Valuation
/moo
Homestead
Valuation
/70
Garage (5)
Total (6) a 70
(7)
Other Irarove eats
To • Iaroroverents - Line (6) plus (7) equals (8) (B)
I he eby certify the above is true, correct, and complete.
Date
- ACTION BY AUDITOR -
Date:
A=roved: