HomeMy WebLinkAboutHomestead_ChannellFORM Bc fo 1979
Prescribed By State Board of Tax Commissioners
To Be Filed in Buplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19_11 &11101
n SEE BACK FOR FILING INSTRUCTIONS Qr--C) ey�- 90%73 -00
We) r � �-a..��¢ ( �rtify that on the 1st day of
varch, 19— (We) occupied as our p cipal place 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 interest in the taxpayer
Property Description in /I //�/
Taxing District (City, Town, Township): L
Parcel Number
If buying on contract: Owners name ('- 5 np1p
my —Township
or legal description shown on tax statement:
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 and complete.
A 1,21) 1 n .. . ,_
Street Address - Gty. State and
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 -
True Cash Assessed Homestead
Value Valuation Valuation
Land not exceeding 1 (one) acre immediately
surrounding residential improvements (1) �O .1Zb`0 2
Other Land O
Total Land F L
(3) SO —00 X80
Residential Improvements (a) ( 0
'? Z 3nl� -
Garage (5) O
0
Total sa / O �S O��o �7
Other Improvements �)� — —
rAUDfTOR
To Improvements - Line (6) plus (7) equals (8) (8) %� O O
I �,by certify the abov is true. corre . and complete.
Signature of Assessor TI Oa:e
A ON BY AUDITOR - - -- _ ___
Approved: Date: